Please help us carry out our mission with a donation.

Please print out this page and complete the form.

Name:
	First / Middle / Last
Address:
	Street
	City / State / Zip
Phone Home:
Donation in Honor of___ in Memory of ___ Other:___
	Name of person for whom you are making this donation
Send acknowled- gement to:
	Name of recipient
:	Street address of Recipient
	City / State / Zip of Recipient

We will gratefully acknowledge all contributions.

Make your check payable to St. Lucy's Auxiliary to the Blind and mail it with the completed form to:

Lynn Hagan
339 Parkway Drive
Pittsburgh, PA 15228