Visions of Strength 2015

Fine Wines, Spectacular Silent Auction, Gourmet Food
Thursday October 22nd, 2015

First Name Last Name Title Company
Address City State Zip
E-mail Phone Fax
How would you like to be recognized?
I would like to:
Please charge my credit card for the following amount
Card Type Card # Expiration Date (MM/YY) Signature
You also may print this form and send a check made out to the Karen L Mosseau fund and mail to
Karen L Mosseau Fund
Northeast Health Foundation
2224 Burdett Avenue
Troy NY 12180
To be included in the invitation, information must be received by: July 31, 2015.
To be included in the program, information must be received by: September 18, 2015.
For more information, please contact KJ Jenkins at (518) 271-5032 or email at
St. Peter's Health Partners
Learn about the united organization
St. Peter's Health Partners
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