How would you like KMHS to use your gift?*

Crisis Services
Housing and Homelessness
Adults and Older Adults
Children and Families
General Operations
The Starfish Fund
Pendleton Place Welcome Baskets

Do you grant permission to share additional gift details?*

Yes
No

Your gift amount, designated to Pendleton Place Welcome Baskets, may be shared with the League of Women Voters of Kitsap County as part of this endeavor. Do you grant permission for Kitsap Mental Health Services to share additional gift details with them (Donor Name(s), Contact Information, Tribute Information if applicable)?

Contact Information

Title

First Name*

Last Name*

Joint Gift

(Name of spouse/partner)

Address*

Street Address Address Line 2 City State Zip Code

Phone*

Email*

May we add you to our Mailing List?*

Yes
No
I'm already on the mailing list

Tribute Information

If you wish to make your gift a tribute to someone special to you, please provide the name of the person you wish to honor and contact information for anyone who should be notified of your generosity.

Is this gift a tribute to someone special?*

Yes
No

In Honor of

Occasion

(e.g., Birthday, Anniversary)

In Memory of

Would you like your gift to be anonymous?*

Yes
No

Would you like your gift amount disclosed?*

Yes
No

Please Notify

Name

Relationship

(Relationship to person in whose honor or memory this gift is made)

Mailing Address

Street Address Address Line 2 City State Zip Code

Matching Gifts

Your employer may match your contribution. If so, please consider requesting a match on your gift to Kitsap Mental Health Services.

Will you send your company's matching gift form to Kitsap Mental Health Services to increase the impact of your gift?*

Yes
No

Please send your company’s matching gift form to:
   Kitsap Mental Health Services
   Attn: Development and Community Relations
   5455 Almira Drive NE
   Bremerton, WA 98311

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Contact Information

Tribute Information

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Matching Gifts

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