Please print this form, fill it out, and mail us at:

HARBOR, Inc.

PO Box 112

Harbor Springs, MI 49740


First Name: ______________________________ Initial: _____ Last Name: ___________________________

Spouse's Name: __________________________ Initial: _____ Last Name: ___________________________

Your Mailing Address: ____________________________________________________________________

City: _____________________________________________ State: ________ Zip: ____________________


Home Phone: _________________ Work Phone: ___________________ Email: ________________________

E-mail: ________________________________________________________________________________


Amount of Donation $ _______________________________

Check enclosed __________ OR Visa/MasterCard/Discover # _________________________ Expiration date __________