Cascade Valley Hospital Foundation - Memorial Gift Donation Form

Well-Wishes Donation
Cascade Valley Hospital Foundation

Please accept my gift of help in the following area:

___ Capital Equipment Fund

___ CVH Lifeline Program (Medic Alert System)

___ Unrestricted - Use where needed most

___ Other: _________________________

Your name: ________________________________________________________

Address: __________________________________________________________

City: _____________________________________________________________

Send my wishes to: __________________________________________________

Send card to: ______________________________________________________

Address: __________________________________________________________

City: ____________________________ State: _______ Zip: ________________

Is the recipient a patient at Cascade Valley Hospital? ___ Yes ___ No

Occasion:

___ birth

___ anniversary

___ retirement

___ birthday

___ wedding

___ graduation

___ Mother's/Father's Day

___ promotion

___ other:_______________________________

Message: ____________________________________________________________

____________________________________________________________________

Enclosed __$5 __$10 __$25 __$50 __$100 __$250 __Other: $____________

CVH Foundation is a 501(c)3 non-profit organization. Gifts to CVHF are tax-deductible.

Thank you in advance for remembering your "Well-Wishes" to CVHF.

Make check payable to: Cascade Valley Hospital Foundation
Complete form and mail to:

C.V.H.F.
Attn: Joan Miles
330 S. Stillaguamish
Arlington, WA 98223