Yes!  I am interested in making a donation to:

AHM Youth and Family Services, Inc.

I am enclosing:
$25                $250            $2,500
$50                $500            Other (specify): $_______
$100              $1,500
I would like to pledge: Monthly $______    Quarterly $______

My employer will match this donation.
Please provide company name:

Title: Mr. Ms. Mrs. Miss Mr. & Mrs. Dr.       Donor's Name:
Address:
City:      State:       ZIP Code:
Phone: ()

If you would like your donation to go to a specific AHM program, please specify here:

Please check if your donation is for one of the following:
General Operating Budget               Facility Fund
Children's Trust Fund (CTF)             Leave a Legacy
AHM Scholarship Fund                    Tree of Life

For donations made to AHM Children's Trust Fund, Tree of Life, or Facility, it is possible to dedicate your gift if you choose to do so.
    This donation is in honor of:    ________________________________
    This donation is in memory of: ________________________________

If you would like us to send an acknowledgement regarding the above dedication, please provide us with the following information:
    Name: ________________________________
    Address: ______________________________
                   ______________________________
    City: ____________________        State: ____      ZIP: _______

On behalf of AHM, we would like to thank you for your generosity.