MY GIFT TO STELLA

To Honor and Remember

• Gift in Honor of
• Gift in Memory of
• General Donation

       (please continue to the “Your information section”)

Name (s):  ____________________

Please send an acknowledgement to:

_____________________________

Your Information:

 _____________________________

Name

______________________________

Address

______________________________

City                             State           Zip

______________________________

Phone

______________________________

Email

Please accept my gift of:

� $1000 (Mercy Society)  � $500  � $250

� $100 � $50  � $25  � Other $_______

�  Enclosed is my check made payable to Stella Maris.

Please charge my gift of to:

� Visa   � Mastercard    � American Express  � Discover

_________________________________________

Card Number

_________________________________________

Expiration Date

_________________________________________

Name on Card

_________________________________________

Signature

Please print and complete this form and enclose your preferred method of payment. Send you gift to:

The Development Office at Stella Maris

2300 Dulaney Valley Road

Timonium, Maryland  21093

Thank you for your generous support.  All gifts are tax-deductible to the full extent of the law.  All gifts receive a receipt for tax purposes by return mail. 

For more information, please call 410-252-4500 extension 7268.