Please accept my tax deductible contribution to Spectrum Support, Inc. in the following amount:

_____   $100
_____   $200
_____   $300
_____   $500
_____ $1000
_____  other

Name: _______________   ___   _________________
Address line 1: _______________________________
Address line 2: _______________________________
City______________________ State______________

Zip code: _________
Telephone: (_____)   ______   -   ________
E-mail: _________________@___________________

Check enclosed ____

OR
Credit Card (type) _________ (number) _________________________
Signature _______________________  Date: _________

__ Please contact me
__ Please send me more information about Spectrum Support, Inc.   
__ Please send information about including Spectrum Support, Inc. in my estate planning

Spectrum Support, Inc.
Carrolltown Health Care Centre
1643 Liberty Road
Suite 205
Eldersburg, Maryland 21784
T: 410-795-6543
Fax: 410-795-6544
www.spectrum-support.org
E-mail: lconlon@spectrum-support.org