"Investing in People"

Please complete the following form and submit with your gift to:

LifeQuest Foundation

804 North Mentzer

Mitchell, SD  57301

Name:

Business Name:

Address:            Apt/Suite #:

City:   ST:    Zip:

Home Phone:    Work Phone:

E-Mail:

Amount of Gift:

Cash    Check    Credit Card*    Pledge     Other:

* Complete Credit Card form below

Check appropriate box:

Annual Gift    Memorial Gift**    Honor Gift**

** Complete Memorial/Honor Information form below

Memorial or Honor Gift Information

In Honor/Memory of:

Send acknowledgement to::

Mailing Address:

City:   ST:    Zip:

Credit Card Information

MasterCard    Visa

Credit Card#:    Exp Date:

Return to LifeQuest Foundation Home Page

Return to LifeQuest Home Page