TCMH Foundation Donation
DONATE ONLINE
Note: For online donations, you will be redirected to PayPal’s website. You do not have to have a PayPal account to donate.
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DONATE WITH CHECK OR CREDIT CARD
I would like to contribute: ___ $1,000 ___ $500 ___$250 ___$100 ___$50 ___$25 ___Other gift $ _______
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CREDIT CARD
Please charge $ _______________ to my ___Visa ___MasterCard ___American Express
Card No. __________________________________________________
Expiration date: _____________________
Print name as it appears on the card ________________________________________________________________
Signature _____________________________________________________________________________________
CHECK
Enclosed is my check for $____________________________, made payable to TCMH Healthcare Foundation.
(Your gift is tax-deductable to the full extend allowed by law.)
Name _____________________________________________________________________________
Email address _____________________________________________________________________________
Address _____________________________________________________________________________
State _____________________________ Zip ________________ Telephone ______________________________
EMAIL OPTION
___I would like to receive email updates from TCMH Healthcare Foundation.
Emails are sent to TCMH Healthcare Foundation subscribers only. TCMH does not sell, trade, rent or share personal information about ourusers to or with any third parties. Email updates are intended for TCMH consumers and patients 18 years of age and older.
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Print off form and send to:
TCMH Healthcare Foundation
1333 S. Sam Houston Blvd.
Houston, MO 65483
Questions may be sent to jgentry@tcmh.org.