Print & Mail to:
The Mental Health Association in Ulster County, Inc.
P.O. Box 2304, Kingston, NY 12402

The mission of the MHA is to engage all people in optimal mental health by providing
innovative programs and services that heal, prevent, educate and advocate.

CONTRIBUTION FORM

Donor Name(s) ____________________________________________________________________

Address __________________________________________________________________________

City/State/Zip ______________________________________________________________________

Email ____________________________________________________________________________

Enclosed is my tax-deductible contribution of _______________________________________________

Memorial and Special Occasion Gifts allow you to remember or honor a loved one, a friend, a relative or a special occasion. If you would like your gift used in this way, please complete the information below:

I wish to make this gift ___ in honor of or ___ in memory of:

Name ___________________________________________________________________________
Your gift as a memorial/tribute to a friend/loved one will be
acknowledge to the person/family you designate.

Please notify:

Name ____________________________________________________________________________

Address__________________________________________________________________________ _

City/State/Zip ______________________________________________________________________

Please make checks payable to:
Mental Health Association in Ulster County, Inc.
Contributions are tax deductible to the full extent allowed by law
and go directly to the support of our programs and services.

The MHA in Ulster County is a United Way Agency and an
Affiliate of the State and National Mental Health Association

A copy of the latest Financial Report filed with the Department of State may be obtained by writing to:
NYS Department of State, Office of Charities Registration, Albany, NY 12231, or by writing to the MHA.

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