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Donation/Tribute Form

Your contribution to Kadima enables adults with mental illness in our community to lead lives of dignity, self respect and independence. Please make checks payable to Kadima. All contributions are tax deductible, as permitted by law.

For your convenience you can submit this form or print and mail it with your contribution to:

Kadima
15999 W. Twelve Mile Road, Second Floor
Southfield, MI 48076

*Denotes required fields.


Donor Information

*Donor's First Name:   *Donor's Last Name:
*Address:
*City:
*State:   *Zip Code:
*Phone:
Fax:
E-mail:

*Donor's name as it should appear on acknowledgement:


*Enclosed is my gift of: Caring Hands ($50 plus)
(Each Caring Hand tribute will be acknowledged with a special certificate.)

Double Chai ($36)

Chai ($18)

Regular ($10)

Other
If Other, please fill in amount:

 
*Please charge to my bankcard: Visa   MasterCard
*Account Number:
*Expiration Date:
 
*My gift is for:

General Fund

Other
If Other, please select one from following list:

 
I wish to make a gift: in memory of:

in honor of (occasion):

 
Please send an acknowledgement card to:

*First Name:   *Last Name:
*Address:
*City:
*State:   *Zip Code:
 
For more information, please call 248.559.8235.



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15999 W. Twelve Mile Road, Second Floor
Southfield, MI 48076

248.559.8235
fax 248.559.0229

©2002 Kadima