To donate, simply complete this form and click on the "Print" button and mail or fax it to:

MENTAL HEALTH ASSOCIATION
OF FRANKLIN COUNTY, INC.
538 E. Town St., Suite D
Columbus, OH 43215
Fax: 614-221-1491

* Title
* First Name
* Last Name
* Street Address
* City
* State
* Zip
* Phone #
Email
* Type of Donation
 Donation to the MHAFC
A gift in memory (Please fill out below).
A gift in honor (Please fill out below).
A gift to commemorate a special occasion (Please fill out below).
* Contribution Amount
 $250
$100
$50
$25
Other $
If you are making this donation in memory or honor of someone or to commemorate a special occasion, please fill out the remainder of this form.
Individual(s) who is being honored or remembered:
Title
First Name
Last Name
Special Occasion
Send acknowledgement card to:
Title
First Name
Last Name
Street Address
City
State
Zip
* Indicates required field.