Donation Form - Beacon House, Inc.

We make a living by
make a
life by
what we
give . – Winston
what we get.
Beacon House Donation Form
You can select how your donation will be spent by choosing from one of our programs, the Adopt
campaign, or to provide general support:
Renewing Life program [$90 participant fee for 8 sessions]
Expressive Arts programs [$20 program fee / person]
Educational Speaker programs [any amount]
General operations [any amount]
Other amounts □ [$25] □ [$50] □ [$75]
Adopt-the-Beacon House (check your donation level below)
□ $9,000 one-time endowment & permanent placement on Adopt-the-Beacon House Wall
Ray of hope □ $3,300 annual gift to subsidize programs / operations
□ $300 to pay rent for one month
□ Other amount $_________________
Please state exactly how you wish your gift acknowledged on the Adopt Wall (family, group, organization, in honor of, etc.)
____________________________________________________________________ □ Check for Anonymous
Check payment made on _____/_____/_____ or installments of $__________ beginning _____/_____/2013.
(For credit card payment, visit and use the secure Gift Basket page for Beacon House.)
Send your check with this donation form to: Beacon House, Inc. PO Box 1175 Green Bay, WI 54305-1175
Print Name: _______________________________________________________________________
Your Signature: _____________________________________________Date:__________________
Address: _______________________________________ City/State/Zip: _____________________
Email: ________________________________________________________________________
Telephone: (_______) _________________________
Thank you for thinking of Beacon House, Inc. in your charitable giving!
Your valued gift is tax deductible to the extent that is allowable by law.
“Beacon House
supports a whole
person approach
to helping those
experiencing life
changing health
situations. The
programs and
services address
the body, mind &
spirit of healing.
I'm grateful to
have this in our
– Mary A.
Connelly, MD
Bellin Health –
The Cancer