MEMORIAL/DONATION FORM
(Right-Click on this page to print it out,
fill it out and return it with your gift to Crossroads House)
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CROSSROADS HOUSE I would like to make a donation of $__________________ in memory/honor of:______________________________
Please send notification of this gift to:
Name:__________________________________ Address:________________________________ City:____________________________________ State:___________________________________ Zip:_____________________________________
From:
Name:__________________________________ Address:________________________________ City:____________________________________ State:___________________________________ Zip:_____________________________________
Please make checks payable to:
Crossroads House
P.O. Box 403
Batavia, N.Y. 14021 May the knowledge that your gift will help others bring joy to you.
Thank you!
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