Please make your check payable
to:
S.M.A.R.T.
Enclose this form with your donation and mail to:
S.M.A.R.T. TEAMS
PO Box 444
Springhill, Kansas 66083
Date:
__________________
Enclosed is my check in the amount of
$________ payable to S.M.A.R.T.
My
name:______________________________________
Address:_______________________________________
City/State/ZIP:__________________________________
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OF DONATION (please choose one):
General donationGift in memory of:
_____________________________________________ (name of deceased)
(relationship)
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______________________________________________(name of
individual)(relationship)
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