Visions of Strength 2016

Fine Wines, Spectacular Silent Auction, Gourmet Food
Thursday October 20th, 2016

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
310 S. Manning Blvd
Albany, NY 12208
To be included in the invitation, information must be received by: August 5, 2016.
To be included in the program, information must be received by: September 23, 2016.
For more information, please contact KJ Jenkins at (518) 525-1265 or email at kj.jenkins@sphp.com.
St. Peter's Health Partners
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St. Peter's Health Partners
© 2016 St. Peter's Health Partners. All rights reserved. A Not-for-Profit Network.
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