10/29/2022
Consider membership:
MEMBERSHIP
Please Add / Renew My Membership at the Following Level: (PLEASE CHECK ONE)
Regular $10 Family $25 Supporting $50
Patron $100 Other $______
Please Designate for: ______________________________
SPECIAL GIFTS: Enclosed is an extra Donation of $__________________ in Memory or Honor of:
______________________________________________________________________
Acknowledgement to be sent to: ___________________________________________
___________________________________________
Please accept our sincere thanks for sustaining the Community Health and Wellness Fund. Your participation will enable us to continue to provide support for quality programs and services to our communities from Long Lake to Forestport. Membership entitles you to a vote at the annual meeting.
Name:_________________________________________
Address: _______________________________________
_______________________________________________
501(c)3 not-for-profit organization. All dues and contributions are tax deductible to the extent allowable by law.
Please return to:
Community Health & Wellness Fund
PO Box 207
Old Forge, NY 13420
Quality Health Care Can Always Use a Helping Hand!
