Aging Enriched Donations Golf

Lutheran Homes of Michigan Inc is a 501(c)(3) organization. Please consult your tax advisor regarding deductibility.

Title

Mr.	Mrs.	Miss	Ms.	Rev.
Dr.

First Name:

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Last Name:

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Paying for myself Paying for myself and others

Names of others in my group

Mailing Address:

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City:

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State:

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ZIP:

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Phone:

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Email:

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Please do not send me promotional material.

Payment options

Contribution Amount (Pick the number of people you are paying for):

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Card Type:

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Visa	Mastercard
American Express	Discover

Card Number:

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Expiration Date:

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3-digit Security Code (on back of card):

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Please fill in the Security Code before submitting your donation:

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