Donate to The Wellness Community
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Please complete all applicable fields, print the form, and enclose it with your check addressed to:

The Wellness Community – Central Indiana
8465 Keystone Crossing, Suite 145
Indianapolis, IN  46240-2453

I/We would like to make a tax-deductible* donation of US$  to help provide free programs of emotional support, education, and hope for individuals and families affected by cancer.

Donor Information:
First Name:
Last Name:
Mailing Address:
(be sure to include apartment or suite number)
City:
State:
Postal Code:
Country: 
Daytime Phone:
Evening Phone:
E-mail address:

Designation:

This gift is given to The Wellness Community – Central Indiana:

As a general contribution in support of individuals and families affected by cancer.

In Honor of: 

In Memory of: 

On the Occasion of: 

For the Speedy Recovery of: 

Gift Acknowledgement:

Please send a Gift Acknowledgement Card to:
First Name:
Last Name:
Mailing Address:

(be sure to include apartment or suite number)
City:
State:
Postal Code:
Country: 
(Gift amounts are not reflected on Gift Acknowledgment Cards.)

Please include this message and sign the card from:

Employer Match:

My company/employer  will match this gift.

I am enclosing a completed matching gift form with my check.

Comments:

How did you hear about The Wellness Community?

Select PRINT in your Web Browser then please mail this completed form and check to:

The Wellness Community – Central Indiana
8465 Keystone Crossing, Suite 145
Indianapolis, IN  46240-2453

Thank you for your kind generosity and your support of individuals and families affected by cancer.

*The Wellness Community – Central Indiana, Inc. is a 501(c)(3) tax-exempt, not-for-profit organization. Contributions are tax-deductible to the extent allowed by law.

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