CJ Foundation for Healing Loss
Donation Form
Use your browser's Print command to print a copy of this form.  Complete the form, then mail it to:  CJ Foundation, 25890 Fairview Ave. Suite 201,Hayward, CA  94542.
Please print or type all entries.
Name
Address
City                                                                    State          Zip or Postal Code
Country                                                Daytime Phone  (       )

Enclosed is my tax-deductible gift of:
$25__    $50__    $100__    $500__    $1000__    Other___________
Make your check or money order payable to: CJ Foundation
In memory of ...
To make your gift in memory of a loved one, please complete the information below so that we can acknowledge your gift as you specify.  The gift amount will not be mentioned.
This gift is made in memory of:
Please send an acknowledgement to:

Name
Address
City                                                                    State          Zip or Postal Code
Country                                              

__ I have enclosed my company’s Matching Gift Form
to increase my giving to the CJ Foundation.
The CJ Foundation for Healing Loss is a 501 (c) (3) tax deductible corporation.  All donations are tax deductible to the full extent allowed by law. 

Mail to:
CJ Foundation
 25890 Fairview Ave. Suite 201
Hayward, CA  94542.