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YES, I/we wish to support Amherst Neighbors to make a difference in the lives of
Amherst and Pelham seniors.  All gifts are tax deductible as permitted by law.


Enclosed is my check for $_____________


Name(s)_______________________________________________________________


Street Address__________________________________________________________


City_________________________State_________________Zip Code_____________


Telephone__________________________Email_______________________________



Please tell us if your gift is to honor or remember others:


Name(s) to be honored___________________________________________________


Reason (for example “in memory of”, birthday, anniversary)


______________________________________________________________________


Should we notify anyone of your gift?  If so, provide name and address:


______________________________________________________________________


Please make your check payable to Amherst Neighbors and mail it with this form to: 
Amherst Neighbors, PO Box 3428, Amherst, MA 01004.


Thank you for your generous support!