Name:____________________________________________________________________________

Address 1:________________________________________________________________________

Address 2:________________________________________________________________________

City:__________________________

State:____________________

Zip:_________________

Telephone:________________________________________________________________________

Email:____________________________________________________________________________

I will donate a tax-deductible gift of $______________ to the Center for Grief Recovery.

[Idea for partnering_____________________________________________________________]

[Population serving______________________________________________________________]

[Resources needed______________________________________________________________]

Make your check payable to The Center for Grief Recovery and mail it with this form to:

The Center for Grief Recovery
1263 W. Loyola Ave.
Chicago, IL 60626

We appreciate your generosity.
All contributions are tax deductible. The Center for Grief Recovery is an Illinois non-profit
501(c)(3) corporation. Our Illinois tax identification number is 36-3778554.