Yes, I (we) wish to support the Lewis County Hospital Foundation’s Fund Raising Campaign.

 

 

_____  I (we) would like to give a gift of $_________.

 

_____  My payment of $___________ is enclosed in full.

 

_____  We would like to pay in _____ installments, and have enclosed a check for $_________.

            Please send me a reminder statement in the month of __________.

 

_____  Please use my gift wherever it is needed most.

 

_____  Please restrict my gift for ________________________.

 

_____  Please send information on the Caring and Sharing Recognition Program

 

Please return to:

 

Lewis County Hospital Foundation

7785 North State Street

Lowville, New York 13367

 

Phone:  315-376-5110

Fax:  315-376-2816