TAX DEDUCTIBLE DONATIONS TO ROSALIE MANOR COMMUNITY & FAMILY SERVICES
I would like to participate in the exciting happenings at Rosalie Manor Community & Family Services. Enclosed is my gift of: [ ]$500 [ ]$250 [ ]$100 [ ]$50 [ ]$35 [ ]$____
*Annual gifts of $100 and above qualify for membership in the Founders Society.
Name:	____________________________________________
Address:	___________________________________________
City:	_______________________State:______ZIP:______
Phone:	__________________
[ ] I wish to make a credit card donation.
Credit Card (circle one):	Visa  MasterCard
Cardholder Name:	___________________________________________
Credit Card Number:	___________________________________________
Expiration Date:	___________________________________________
* If you wish to make a credit card donation over the phone, you can contact Dawn Groshek at (414) 449-2868 Ext. 202.
[ ] I wish my gift to remain anonymous.
Gifts may be made in memory of or to honor a family member or friend.
[ ] In memory of:	__________________________________
[ ] In honor of:	_____________________________________
If in honor of, what occasion? [ ]anniversary [ ] birthday
	[ ] new arrival  [ ] other
Address honor/memorial acknowledgement to:
Name:	____________________________________________
Address:	___________________________________________
City:	_______________________State:______ZIP:______
All memorial/in honor of gifts are acknowledged immediately. The amount of your gift remains confidential.
Please complete this form and mail to: Rosalie Manor Community & Family Services Attn: Development 4803 W. Burleigh St. Milwaukee, WI 53210