Providence RMH: Donation Form

Yes, I would like to help families of children being treated at local hospitals.
Enclosed is my tax-deductible gift to support the Providence Ronald
McDonald House.

_$25 _$50 _$75 _$100 Other $______

Your name:______________________________________________________

Address: _______________________________________________________

City: _____________________________ State: ______ Zip: _____________

This gift is in honor of: _____________________________________________

This gift is in memory of: ___________________________________________

Please send acknowledgement to:

Name: _________________________________________________________

Address: _______________________________________________________

City: _____________________________State: ______ Zip: ______________

Please make checks payable to: Providence Ronald McDonald House
45 Gay Street
Providence, RI 02905

Credit Card Information

Please circle one: Mastercard Visa American Express

Amount: _______________

Credit Card Number:_______________________________

Exp. Date: __________

Signature: _______________________________________

Please call us at 401-274-4447 with any questions.