Print this form, complete it and mail it with your check to:

Hope Harbor • P.O. Box 1047 • Claremore, OK 74018

YES, I want to offer a gift of hope that will impact a young life.

Please accept my gift of $____________.

Name:
 ________________________________________
Mailing Address:
 ________________________________________
City, State, Zip:
 ________________________________________
Phone:
 ________________________________________

Type of donation:
     ______ Memorial     ______ Honor

Name of person memorialized or honored:  ___________________________
Send acknowledgement to: ________________________________________
Mailing Address:
 ________________________________________
City, State, Zip:
________________________________________