This form is available to assist you in supporting local hospital services through a cash donation, planned gift such as a future estate bequest, a new life insurance policy or transfer of an existing one, gift of publicly traded securities (full tax credit for market value, plus 50 per cent savings on capital gains tax!) or another type of gift.

Please print this form and mail to the Huronia Hospitals Foundation care of either hospital, with your cheque or money order or drop it off at HDH or PGH.

If you require additional information do not hesitate to contact the Foundation staff. You may also wish to fill out the voluntary donor survey by clicking on the title above.

YES, I'll help the Foundation support our local hospitals
Here is my gift today of: $500 $150 $100 $25
Any amount helps $
Please contact me about: an estate bequest a life insurance gift
an appreciated securities (stocks) gift
Please designate my donation to:
Annual capital equipment and building needs
Specific Department or Service (Please List)
Our Best Care Capital Campaign
Endowment Fund
Where it is most needed
NAME:
ADDRESS:
TOWN: POSTAL CODE:
HOME PHONE: WORK PHONE:
COMPANY NAME (if applicable):
E-MAIL:

Please send me more information on future hospital needs and the new Endowment Fund.
Please send me more information on Planned Giving such as estate bequests and life insurance gifts.
I do not wish my name to be published in your Donor Recognition programs


PLEASE MAKE YOUR CHEQUE OR MONEY ORDER PAYABLE TO:
THE HURONIA HOSPITALS FOUNDATION

AND MAIL TO:

1112 St. Andrew's Dr.
P.O. BOX 760,
Midland ON
L4R 4P4