A Promise of Health Donation Form
(Please send this form with your donation)
Mail to:
Web donations
A Promise of Health
P.O. Box 247
Hiawatha, IA 52233
I wish to support A Promise of Health’s programs to bring primary healthcare to the rural Mexico.
I would like to contribute $ _______________ (U.S. currency).
My name is ___________________________________________________________
Address: ______________________________________________________________
City: ___________________________ State: _____________ Zip: ______________
Country: _____________________________
My email is: __________________________________
To make your donation above in memory of, or in honor of, someone special, please fill out the following:
In memory of / honor of (please circle one):
____________________________________________________________________
Please send a card to my honoree to notify them I made a donation in their name.
Name: ______________________________________________________________
Address: _____________________________________________________________
City: _____________________________ State ____________ Zip ____________
Country ________________
A Promise of Health is a 501(c)(3) non-profit organization authorized to receive tax-deductible
contributions as allowed by law. Donations are fully tax deductible.
(Please send this form with your donation)
Mail to:
Web donations
A Promise of Health
P.O. Box 247
Hiawatha, IA 52233
I wish to support A Promise of Health’s programs to bring primary healthcare to the rural Mexico.
I would like to contribute $ _______________ (U.S. currency).
My name is ___________________________________________________________
Address: ______________________________________________________________
City: ___________________________ State: _____________ Zip: ______________
Country: _____________________________
My email is: __________________________________
To make your donation above in memory of, or in honor of, someone special, please fill out the following:
In memory of / honor of (please circle one):
____________________________________________________________________
Please send a card to my honoree to notify them I made a donation in their name.
Name: ______________________________________________________________
Address: _____________________________________________________________
City: _____________________________ State ____________ Zip ____________
Country ________________
A Promise of Health is a 501(c)(3) non-profit organization authorized to receive tax-deductible
contributions as allowed by law. Donations are fully tax deductible.
