I want to help HUGS for Kids prevent child abuse and neglect in Palm Beach and Broward counties.  Please enroll me in the following donor category and place me on your mailing list.

Donor Level
 
$1,000 $500 $250
$100 $50 Other   $
Please keep my gift anonymous.  
Mr.     Ms.     Mrs.  
Name:
Address:
 
City: State: Zip Code:
Phone:   Fax: Email:
Your phone number will only be used if we need to clarify any information on your donation form.  It will not be used for solicitation purposes.

Method of Payment

Card Type:
Card Number:
Expiration Date: / (MM/YYYY)
Name on Card:
Credit Card Billing Address is the same as the
Registration address. If not, please enter the billing address below.
Billing Address:
 
City: State: Zip Code:

Memorial or Honorary Donations

This gift is in honor
 memory		 of   .
Please notify the following person that I have made a gift in the honor/memory of the person noted above.  I understand the amount of my gift is not mentioned in the letter.
Name:
Address:
 
City: State: Zip Code:

If you prefer to pay by check, please download the donation form and mail it with your check to the address on the top of the form.