PLEASE PRINT OUT, COMPLETE AND MAIL THIS FORM TO:

HARMONY HAVEN, P. O. BOX 3305, TERRE HAUTE, IN 47803

We encourage you to give your time and money generously. As a nonprofit 501(c)(3) corporation, all contributions are tax deductible.Harmony Haven, Inc. Membership Application Form

Membership includes Harmony Haven newsletter.

Name _________________________________________

Phone _________________________________________

Address________________________________________

City___________________________________________

State/Zip _______________________________________


____YES, I am interested in volunteering my skills or time to Harmony Haven.

Please list relevant skills or interests.

______________________________________________

______________________________________________

______________________________________________


Membership Donation:

All memberships are annual except Lifetime.

TYPE:
___
Regular $15 ____Family $25 ____Supporting $50

____Sustaining $100 ____Lifetime $500


THANK YOU FOR YOUR SUPPORT!