Memorial Health Foundation

Memorial 2020 Campaign (one-time gift)

Thank you for joining hundreds of supports as together, we create a new standard for healthcare through the Memorial 2020 project. To finalize your one-time gift, please complete the information below. If at any time, you have questions or you would rather provide a pledge payable over multiple years, please contact the Foundation office at (937) 578-4272.

Donation Amount*
$

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Recognition Information

Contributions of $250.00 or more will be acknowledged with a comprehensive commemorative display of campaign donors. May we include your name? (yes or no)
It is fine to include my/our name(s) with the published list of donors? (yes or no)
Name of Donor(s) as you wish it to appear in all recognition

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

Share This Form

Powered by eTapestry.