Donors: Contact Info Form – Lakes Region Mental Health Center

Donors: Contact Info, Feedback, & Preferences

Thank You For Supporting LRMHC

Please fill out the form below so we can make sure your information in our system is current. We'd also love to hear some feedback from you as well!

Donors: Contact Info, Feedback, & Preferences

* Field Label

First

Last

* Preferred Address

Street Address

Address Line 2

City

State

ZIP Code

* Preferred Email

* Preferred Phone Number

* Preferred Contact Method:

Paper/Letters via US Mail

Phone

Select all methods of communication you are comfortable with

Why is LRMHC's mission important to you? Why have you supported us in the past?

Is there anything WE can do for YOU as a donor?

What is your birthday?

We'd like to acknowledge donor birthdays! If interested, please share your birthday.

SIGN UP TO BECOME A SPONSOR TODAY!

* CONTACT NAME

First

Last

BUSINESS NAME

Please enter business name if you are donating from your business.

* CONTACT PHONE

* CONTACT EMAIL

Confirm Email

* Address

Street Address

Address Line 2

City

State

ZIP Code

WEBSITE ADDRESS

So we can link to your website!

* INCLUDE BUSINESS LOGO?

YES

UPLOAD LOGO

Max file size is 15 MB. Please upload company logo or email to sshiel@lrmhc.org

* PRODUCT/SERVICE DESCRIPTION

Be as descriptive as possible so we can accurately present your donation!

* VALUE ESTIMATED AT

ANY RESTRICTIONS?

Ex: Expiration dates, blackout dates/times, minimum bid requirements, etc.

DESCRIPTION OF BUSINESS

Please fill out if donating from your business.

ANYTHING ELSE WE SHOULD KNOW?

* You will receive an email from sshiel@lrmhc.org within 48 hours to arrange pickup of your donation, if you are unable to mail or transport it.

I ACKNOWLEDGE

(Only applies to those in the local Lakes Region area)