Support CHEER, Inc.
Thank you for your donation!
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Do you or a family member receive ANY CHEER services? (Meals on Wheels, Home Delivered Meals, Adult Day Program, PASA, CHEER Membership, etc.)
*
Yes
No
Is this a donation for services provided?
Yes
No
What CHEER Services are received by you or a loved one? (Check all that apply)
Home Delivered Meals
Adult Day Program
PASA (Personal Assistance)
CHEER Membership
Other
Which service would you like this donation applied to?
Home Delivered Meals
Adult Day Program
PASA (Personal Assistance)
CHEER MEMBERSHIP
Other
Is this donation in memory or honor of someone?
Yes
No
Who is this in memory or honor of?
Please apply my gift to:
Unrestricted (where the need is greatest)
Personal Assistant Care
Home Delivered Meals
Transportation
Adult Day Program
CHEER Centers
Other
My Donation
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