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A Celebration of Thankfulness & Remembrance
I am honoring the following people: (Please circle either memory or honor for each name)

1. In honor/memory of _________________________________________from_____________________________

 2. In honor/memory of _________________________________________from_____________________________

 3. In honor/memory of _________________________________________from_____________________________

 4. In honor/memory of _________________________________________from_____________________________

5. In honor/memory of _________________________________________from_____________________________

Heart of the Redwoods Community Hospice is requesting a donation of $10 for each person honored.

Should you be able to contribute more, it is gratefully appreciated.

Even if you are unable to make a contribution, feel free to return a form and honor a loved one.

Name__________________________________________________________ Address________________________________________________________ Phone__________________________________________________________


Please Mail this form to: HRCH, 464 Maple Lane,Garberville, CA 95542

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