Print this form to make a personal donation to MMHA. If you are not able to print the form, follow the format and mail your donation to the Montana Mental Health Association.

Instructions for form.

1. Make check or money order payable to: Montana Mental Health Association
2. Enclose your day time phone number and return address.
3. Mail completed form and donation to:
   Montana Mental Health Association
   PO Box 88
   Bozeman, MT  59771

____Yes, I want to help! I want to be a part of the mental health movement making a difference for millions of children, young adults, and the elderly who often are overlooked and under-serviced as well as those who do suffer with a mental illness.

____Enclosed is my check or money order.

____I have included my credit card information.

Your name____________________________________

Business____________________________________
Street_____________________________________
Apt/Suite__________
City_____________________________
State______________
Country____________
ZIP________________

Email Address___________________________________

Day time phone number (____)______________________

If using a credit card, please provide the following information:

Amount of contribution: $______________________
Credit Card Number:_________________________
Credit Card: (Mastercard/Visa/American Express) Expiration Date:___/___
Card Holder Phone: (_____)___________________

Contributions are tax deductible to the extent permitted by law.

Thank you for being so thoughtful Your gift to the
Montana Mental Health Association is truly appreciated.