Donation Form

The Sharon Heller Scholarship

In loving memory of Sharon

Donation Information

Amount

$500

$250

$100

Type of Donation

One Time DonationRecurring Donation

I would like to dedicate this donation

In Memory of

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Contact Information

First Name

Last Name

Company Name

Address

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Home Phone

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Credit Card Information

Card Holder Name

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Expiration Date

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Billing Address

Same As Above

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The Habilitation Center of Boca Raton is a 501(c)(3) nonprofit charity. For tax purposes, our EIN# is 59-1859543. Within the limits of law, your gift is 100% tax-deductible.

A COPY OF THE OFFICIAL REGISTRATION (CH17266) AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (1-800-435-7352) WITHIN THE STATE OF FLORIDA. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATIONS BY THE STATE.

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