Love Donation

Please print clearly

Name:_______________________________________________________________

Address:_____________________________________________________________

City:_____________________________________ St:__________ Zip____________

Day Phone:_________________________ Evening Phone_______________________

Love Gift enclosed: $_____________________________

Relationship to child ______________________________________________________

Child's Name:___________________________________________________________

Birth Date:____________________________ Death Date:_______________________

Please include my child(ren) as listed above in “Our Children Remembered “list as
published in the newsletter. Yes ___ No___

Print this form, fill it out and mail it to
TCF Myrtle Beach, c/o Jane Alirie, 706 Bonnie Dr., Myrtle Beach SC 29588