Mail-in Donation Form
Thank you for supporting me as I participate in the
Kalamazoo - Portage Walk
Participant Name: Kody Hillring
Participant ID: 8594614
Team Name: Kevin Hillring
Step 1. Print Billing Information
First Name: Last Name:
Address:
City: State: Zip:
Phone: Email (optional):
Address is different than one on check. Please use above address.
Step 2. Select Donation Details
$500 $250 $100 $50 $25 Other $
Cash
Check # , made payable to: The ALS Association
Credit card #: exp: /
Signature:
Signature:
Name for Participant's Donation Scroll (ex: The Smith Family or Aunt Sue):
Step 3. Mail it in
Please only attach one donation per form and always use a security envelope. Send this form with your donation to:
The ALS Association Michigan Chapter
Attn: Walk to Defeat ALS
6352 Fulton St E
Suite 600
Ada, MI 49301
Please note that it may take up to 2 weeks to post your donation online.
For Office Use Only:
Check # Cash $
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