Sponsor-A-Ride

Donation Purpose

I would like to make a general donation to help seniors in my county.

I would like to sponsor an individual senior.

Individual's Information
Name:	*
Phone:	*
Date of Birth:	*
Home Address:
City:
State:
Zip:
County: Clark Cowlitz Klickitat Skamania Wahkiakum

Best Use of Funds Donor may select to use or not use any publicly funded transportation programs the clients may be eligible for, such as Medicaid.
Use Client/Sponsor fund first. Use other funds client may be eligible for first.

Client Funds General Purpose Specific Purpose
	Shopping Centers/Grocery Stores Senior Nutrition/Meals Health Appointments Socialization/Recreation Personal/Other

General Purpose

Specific Purpose:

I/We request that this gift remain anonymous.

Feel free to list or announce this gift to inspire other donors.

Please use the following in all acknowledgements:
In honor of:
In memory of:
Other:

When you are finished, proceed to the checkout page:

Human Services Council is a 501c (3) nonprofit organization. Contributions are tax deductible as permitted by law. Tax Id# 91-0786572.

Improving People's Lives in Southwest Washington