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MHA Secure Donation Form

Membership Memorial or Tribute General Contribution Special Project:

For information about making a planned gift or donating stocks or property, please contact our gift office at 888-242-2522, ext. 225.

I’m making a donation of $

As you fill in the form, please note that * indicates a required field. Please provide us with:

Your information

(Please make sure that your name and address is as it appears on your credit card.)

Name*:
Business:
(if applicable)
Address*:
Apartment/Suite:
City*:
State*:
ZIP*:
Phone number:
(in case we have questions)
E-mail*:

Credit card information

Type of credit card*:
Account number*:
Card Code*: what is this?
Expiration date*: (mm/yy)

Memorial/tribute gift information

in memory of  -or- in honor of on the occasion of

(Please indicate occasion such as birthday, birth, wedding, anniversary, graduation, holiday, or other milestone or special occasion.)

Please send memorial/tribute card to:

Name:
Address:
City:
State:
ZIP:
How would you like your card signed?

If your employer has a matching gifts program, please call our office at 888-242-2522, ext. 225.

The National Mental Health Association of Greater Los Angeles (MHA) is a private, nonprofit organization, and your gift is tax-deductible. Your credit card transaction is secure, and we never share your private information.

Thank you for your support!




Mental Health America of Los Angeles   Administration Offices
100 W.Broadway, Suite 5010   Long Beach, CA 90802-2310
888-242-2522, ext. 225    development@mhala.org

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