Name/s (as you wish it to appear in print)  

Address  

City, State Zip   

In Memory of:   
OR
In Honor of:   

Please notify the following individual(s) of my gift. (No amount will be mentioned)

Name:   

Address:   

City, State Zip:   

      Please check if you DO NOT want your name listed as among the donors.

Please select the Foundation which your check is payable and your gift is  credited.
      Berrien Community Foundation, serving Berrien County
      Michigan Gateway Community Foundation,
                serving Niles, Buchanan and Cass County

Print this page with your completed information.

Make your check payable to the Foundation selected above.

Mail your check and form to:    Volunteer Center of Southwest Michigan
                                                1213 Oak Street
                                                 Niles, MI 49120

Thank you for your support.

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