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Donate

Donation Form

    Donations are the backbone of our existence, providing the means for counseling, treatment and rehabilitation.  Please support your Community Treatment Centers by pledging your donations today.  Please print and fill out the form.  Make all checks payable to Community Treatment Center and mail to:  1215 Lake Drive,  Cocoa, FL 32922.  We sincerely thank you for your support.

Name:
Address:
Day Phone:                                                     Evening Phone:
Check Enclosed:    ___________ YES   __________  NO___________
Bill Me:   ____________ Monthly  ____________ Annually
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OUR FOUNDATION

OUR PILLARS
Bronze - $ 25 per month (Annual $300) ________ $1,500 - $ 2,000 Gift __________
Silver - $ 50 per month (Annual $600)__________ $ 2,100 - $ 5,000 Gift __________
Gold - $ 75 per month (Annual $900) __________ $ 5,100 - $ 7,500 Gift __________
Platinum - $100 per month (Annual $ 1,200)______ $ 7,501 - $ 10,000 Gift _________
Other: _____________________________  
   

Every donation, every gift, no matter the size....really does make a difference!

 

 
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