Coalition for a Healthy Darke County
209 East Fourth Street, Greenville, Ohio 45331
Phone (937) 548-2102 l Fax (937) 548-5608
[email protected]
Mission Statement: To bring our entire community together to create and
maintain healthy lifestyles for all residents and businesses in Darke County.
DONATION FORM
Donations can be made to the Coalition for a Healthy Darke County by Check.
A gift receipt will be sent to you for your donation.
Please complete the form below and include with your check.
Donation Type:
General
To be used for:____________________________________________
Date:_______________
I am enclosing a donation in the amount of: $___________________________
Donated by
Name(s):_____________________________________________________________________
Address:_____________________________________________________________________
City, State, Zip:________________________________________________________________
Phone, Email Address (optional):__________________________________________________
GIFT RECOGNITION
The Coalition understands that donations are given out of kindness, generosity and compassion for
our fellow community members. In recognition of the H.E.A.R.T. behind each and every gift, all donors
will be acknowledged under their respective giving levels on the Coalition Partners & Donors page of
the Coalition for a Healthy Darke County website, unless anonymity is requested.
I request my donation remain anonymous.
GIVING LEVELS
H - Helping
$1 - $249
E - Enabling
$250 - $999
A - Activating
$1,000 - $4,999
R - Revitalizing
$5,000 - $9,999
T - Transforming
$10,000 or more
Please make check payable to:
Coalition for a Healthy Darke County
Please send form and payment to:
Coalition for a Healthy Darke County
209 East Fourth Street
Greenville, Ohio 45331
For more information contact:
[email protected]
(937) 548-2102
Coalition for a Healthy Darke County is a tax exempt 501(c)(3) corporation.
Your contribution is tax deductible to the extent provided by law.