Hudson Valley/Rockland/Westchester NY Chapter MEMORY WALK DONATION FORM

Name of Volunteer who solicited donation: Phone:______________________

CONTACT NAME: COMPANY: ADDRESS: CITY: TELEPHONE: EMAIL: FAX: Item being donated:

Value of item donated:

Return to:
Karen Skelton, Regional Administrator Dutchess and Ulster Counties Alzheimer’s Association 2 Jefferson Plaza, Suite 103 Poughkeepsie, NY 12601 (fax: 845-471-8960) (Phone: 845-471-2655)

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