Donation Form

 


Foundation of Saint Joseph's Hospital

Please print this form and send it to:
Foundation Office - One North
Ministry 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).

Unrestricted Fund (where
the need is the greatest) 		Diabetes Center Palliative Care Unit
Alcohol & Drug Recovery
Services ___________		 Dialysis Services Pediatric Unit
Bereavement/
TLC Program		 Heart Services Spiritual Services/
Prayer Team
Birth Center/
Neonatal Unit		 House of the Dove
(Building Improvement
Fund)___________		 Staff/Nursing Education
Cancer Services Intensive Care Unit Other

I would like my gift to be a memorial for__________________________________
Please notify (family) _________________________________________________
(Notice of you gift is sent with no amount mentioned.)

Address ____________________________________________________________
 
Donor's Signature _________________________________ Date ___________


If you have any questions, please call the Foundation office at 800.221.3733, extension 79502 or 715.387.9502. Thank you for your generosity.
 
 
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