Donor Form

Please submit the following, or if you prefer, download the .pdf form, print and mail to:
Northland Therapeutic Riding Center
P.O. Box 1267
Kearney, MO 64060


This is not a secure document. Please provide the following and we will contact you for further donation information.

Name:

Address:

City: State: Zip:

Home Phone: Work Phone:

E-mail:

$45 provides a helmet to keep our riders safe
$60 provides one therapeutic riding lesson for a child or adult
with special needs
$80 provides two hours of training for our special horses
$360 provides one, six-week therapeutic riding session for a child or
adult with special needs
$375 provides one month of food and care for one special horse

Please use my gift of $ to support:
Riders Horses Equipment Where needed most

TRIBUTE FUND
If you are interested in giving a gift as a memorial or in honor of someone's birthday or other special occasion, please complete the following information:

Memorial Birthday Special Occasion
(please list)

NTRC will send an appropriate acknowledgement to:

Name of person honored:

Name of person to receive acknowledgement
(if different from person honored):


Address:

City: State: Zip:



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