Your donation is very much appreciated!

Name ________________________________________________________________

Address ______________________________________________________________

City ________________________ State ____________________ Zip _____________

Telephone ____________________________________________________________

__ Yes, I want to ensure the continued high level of emergency care provided by Woodbury Community Ambulance.

I have enclosed a donation for ___$5 ___$15 ___$25 ___$50 ___$100

__ $___________ (other amount - please specify)

Please print and mail to:
Woodbury Community Ambulance, 376 Route 32, Central Valley, New York 10917