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 _________________

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

A Partnership in Caring

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