THANK YOU FOR YOUR GENEROSITY
TO
For planned giving options, please contact the clinic,
910-947-6550.
ENCLOSED IS MY GIFT OF: $ _____________
PLEASE DESIGNATE MY GIFT FOR:
Medications
Non-prescription medications/supplies
General operating fund
Where it is most needed
MEMORIAL GIFT
Name of Honoree:
(please print) ____________________________
We will send a
card to the following person indicating your gift.
NAME________________________________
ADDRESS_____________________________
DONOR INFORMATION
NAME________________________________
ADDRESS_____________________________
STATE ____________ ZIP _________________
PHONE_______________________________
EMAIL________________________________