Orcas Senior Center · Donation Form

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Donation Form

Orcas Senior Center

www.orcasseniors.org (360) 276-2677 admin@orcasseniors.org

Thank you for your generous contribution!

Orcas Senior Center is the Orcas District of Senior Services
Council of San Juan County, 501(c)3.
Senior Services Council of San Juan County Federal tax ID #: 91-1057199.
All gifts are tax deductible.

DONATION AMOUNT

$25

$50

$100

$500

Is this a tribute gift?

Yes, an honorary gift

Yes, a memorial gift

Please provide the name and contact information of the honoree.

Please provide the name of the deceased.

Please provide the contact information for a relative or friend of the deceased.

1st DONOR NAME

First Name

Last Name

2nd DONOR NAME

First Name

Last Name

PHONE NUMBER

MAILING ADDRESS

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Please do not show my name on published lists.