Memorial Fund Donation

Please complete the form below and submit to the SMSA Business Office at the address provided:

Name:  _________________________________________________________

Address:  _______________________________________________________

City:  _____________________State:  _____________ Zip:  _______________

Email address:  __________________________________________________

Donation Amount:  $_______________________________________________

Donation made in Memory of:  _______________________________________

By my signature below, I give SMSA permission to post my name and amount of my donation on their website:

_______________________________________________________________

By my signature below, I am asking SMSA to post only the amount of my donation and not my name on their website:

_______________________________________________________________

Please make check payable to SMSA and mail to the following address:

SMSA Business Office
C/O Ruth Wilson
7881 S. Wellington Street
Centennial, Colorado 80122-3193

SMSA is recognized by the IRS as a non-profit 501 (c) (3) organization.  Your contribution may be tax deductible.
The SMSA will provide you with a thank you letter as a receipt of your donation.