As a friend of Prairie Harvest Human Services Foundation, I would like to help people with serious mental illness by supporting the programs.

  INDIVIDUAL $ 25.00

CONTRIBUTOR $ 50.00

PATRON $100.00

BUSINESS $100.00

OTHER $______ 

Your contribution to Prairie Harvest Human Services Foundation is tax deductible.

Proceeds benefit clients of Prairie Harvest Human Services Foundation.   Thank you!

Name:_____________________________

Address:___________________________

City/State/Zip:_______________________

__________________________________

Telephone:____________________(Home)

                     ____________________(Work)

E-Mail:_____________________________