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Membership/Donation Forms
Please complete either the Membership or Donation Form below:
Membership Gift Form
Name ________________________________
Address ______________________________
City _______________ State ____ Zip _____
Phone ________________________________
Membership Gift Enclosed:
[ ] $100 Professional Membership
[ ] $50
[ ] $25
Other Amount $_______
[ ] Please call me to discuss how I can volunteer
Donation Form
Enclosed is my donation of $____________
In Memory of: ________________________
In Honor of: __________________________
Please acknowledge this donation to:
Name ______________________________
Address ____________________________
City/State/Zip ________________________
[ ] Please check here if your employer offers a matching gift program
Please mail your check and completed form to:
Alzheimer's Services of Cape Cod & the Islands, Inc.
712 Main Street
Hyannis, MA 02601
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