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Please print this form and send it to:
Foundation Office - One North
Saint Joseph's Hospital
611 St. Joseph Avenue
Marshfield, WI 54449
| Donor Name (please print)_______________________________________________ |
| Address_____________________________ Phone_____________________ |
| City_______________________ State________ ZIP ________ |
Your name will appear in our donor recognition publications as listed above unless we are otherwise notified.
Please make your checks payable to the Foundation of Saint Joseph's Hospital.
Contributions to the Foundation are tax-deductible as allowable by law.
Enclosed is my gift of $_____________ to support the following program(s).
I would like my gift to be a memorial for__________________________________
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Please notify (family) _________________________________________________
(Notice of you gift is sent with no amount mentioned.) |
Address ____________________________________________________________ |
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| Donor's Signature _________________________________ Date ___________ |
If you have any questions, please call the Foundation office at 1-800-221-3733, extension 7-9502 or 715-387-9502. Thank you for your generosity.
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