Horticultural Therapy Institute donation Form

Giving Opportunities

Mail: Fill out this form and send with your donation to:

Horticultural Therapy Institute
P.O. Box 461189
Denver, Co. 80246

Fax-in: Fill out this form and fax to 303-388-1914

Name:___________________________________________________

Address__________________________________________________

City:___________________________ State:_______ Zip:___________

Day Phone:________________ Evening Phone:____________________

Email:___________________________________________________

Enclosed is my tax-deductible contribution of:

__up to $50 __$51-$100 __$101-$500 __$501-$1,000 __> $1,000

Apply my donation in support of: __ General contribution __ Educational videos

I authorize the Horticultural Therapy Institute to charge $ __________
to my credit card

Card type: __ MasterCard __ Visa

Card Number: _______________________________________

Exp. Date __________

My gift will be matched by my employer:

___________________________________

The Horticultural Therapy Institute reserves the right to cancel a class if a minimum enrollment number is not met.
In the event of cancellation, students will be notified by mail/phone two weeks prior to class.