Compeer of Johnson County, Iowa
Donation Form

 

Print this form on your computer.   After completing it,
send the form with your donation to the address shown at the bottom.

Name (First, MI, Last):  
Organization:  
Address:  
City:  
State:  
Zip Code:  
Home phone: Area code (           )                -
Work phone: Area code (           )                -
Fax: Area code (           )                -
E-mail:  
Amount of donation:  

Donor's signature:

 

Date:

 


Thank you for your generous gift!  Please make your donation payable to "Compeer of Johnson County, Iowa."  Send the completed form and your donation to:

Michelle Struchen
Program Director, Compeer of Johnson County
Community Mental Health Center for Mid-Eastern Iowa
507 E. College St.
Iowa City, IA  52240

Telephone:  319.338.7884 ext. 245

Fax:  319.338.5686

E-mail:  compeer@meimhc.org



This page was lasted updated on 11/27/2007.