In memory

How many people will you be donating in memory of? *

Who is the donation being made in memory of? *

First

Last

Who is the donation being made in memory of? *

First

Last

Who is the donation being made in memory of? *

First

Last

Who is the donation being made in memory of? *

First

Last

Who is the donation being made in memory of? *

First

Last

Name of person making the donation *

First

Last

Mailing address of person making the donation *

Address Line 1

Address Line 2

City

State

Zip Code

Phone number of person making the donation *

Email of person making the donation

Who should we send a card to making them aware that a donation was made in memory of their loved one? *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How will you be paying for your donation? *

Cash/Check
Credit/Debit/PayPal

If paying by check, please make it out to Gilmer CLC and in the memo section, put “In Memory of (insert person’s name)”

How much will you be donating? *

Total

$0.00