If so desired, please print this form, complete it, and mail it with your check to:
Marla Ceely Lamb Fund
c/o Palliative & Supportive Care of Nantucket Foundation
57 Prospect Street
Nantucket, MA 02554
My Name ________________________________________________
Address_________________________________________________
City ____________________________________________________
State __________________________ Zip _____________________
If appropriate, please complete the information below:
____In honor of__________________________________________
____In memory of________________________________________
I’d like an acknowledgment of this donation to be sent to:
Name __________________________________________________
Address ________________________________________________
City ____________________________________________________
State ______________________________Zip _________________
