8/12/2019 Maine Walks with Haiti: Donation Form 2014

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5th Annual Maine Walks with Haiti - Donation Form

May 31, 2014Walker/Runner Name:

Team Name (if applicable):

I am taking part in Maine Walks with Haiti on May 31st, a 4-mile walk/run around the Back Cove in Portland.

I am participating to support the efforts of Konbit Sante, a Maine-based organization that works in Haiti to

improve health care. Please support this great cause and me by making a donation. For you to receive a record

of your tax-deductible contribution, please include your address and/or e-mail.

** Please make checks payable to Konbit Sante, and write Walk in the memo line. **

NAME ADDRESS E-MAIL Like tobeadded to e-

mail list? Y/NDonationAmount

Submit this form and donations on the day of the walk or mail toKonbit Sante, P.O. Box 11281, Portland, ME04104.

www.mainewalkswithhaiti.org