___ I would like to offer my financial support to Helping Hands and Hearts Hospice.

Name __________________________________________________________

Address ________________________________________________________

City _________________________  State ____________  ZIP _____________

Amount of Contribution __________ All contributions are tax-deductible.

Given in memory of  _____________________________________________

Given in honor of ________________________________________________

Please send an acknowledgement of this donation to:

Name __________________________________________________________

Address ________________________________________________________

City _________________________  State ____________  ZIP _____________

___ I am also interested in participating as a Helping Hands and Hearts Hospice Volunteer.