YES! I want to ensure homeless women and their children get the medical care they need
and deserve. I am enclosing a tax-deductible gift in the amount checked below:

    $50 __       $100 __       $150 __       $250 __       Other __

Please make checks payable to:
Women of Means, Inc.
148 Linden St   Suite 208
Wellesley, MA  02482

If paying by credit card, please fill out the following information and send it to
the address above by mail. You can also Fax this form to: 781-235-6819 or call us at: 781-239-0290.
(please print):

  Check one:      MASTERCARD __       VISA __       DISCOVER  __

Name:
Organization (opt.)
Address:
Address2: (opt.)
City, State, Zip
Card #:
Exp. Date:
Phone:
Your signature:

Optional:
If you would like Women of Means to send a card to the person being honored or
to the family or friend of the person being remembered, please fill in the following:

  This gift is being given:       in honor of __       in memory of __

Name:
Address:
City, State, Zip

Message to include on the card: