Thank you for giving the gift of health to children of the Pacific Northwest. To make a donation, please print this form, fill it out, and fax it to us at (206) 987-4845, or mail the completed form with your donation to:
Children's Hospital Foundation
PO Box 50020 / S-200
Seattle, WA 98145-5020
All the following information fields marked with an * must be filled out to complete your donation.
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First Name*
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Last Name*
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Address*
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City*, State* and ZIP Code*
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Country*
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Phone
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E-mail*
Credit Card*: (Please select one)
Visa
MasterCard
American Express
Discover
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Credit Card Number* and Expiration Date*
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Name on Credit Card*
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Billing Address* (if different from above)
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City*, State* and ZIP Code*
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Country*
Amount*: (Please select one)
$25
$50
$100
$250
$500
$1,000
$______________________________________________________
Or name another amount
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Guild Credit*
If you want your gift to receive guild credit, enter the name of the guild here.
Receive more information on our Guilds.
Fund: (Please select one)
| Children's greatest needs | Child Life Toys | ||
| Uncompensated Care | Congenital Defects | ||
| AIDS Research | Diabetes | ||
| Cancer | Intensive Care | ||
| Cancer Research | Leukemia | ||
| Cardiology | Odessa Brown Clinic | ||
| Center for Children with Special Needs Endowment | Research | ||
| Summer Camp |
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Or name another Fund
Memorial or Special Occasion: (Please select one)
In Memory of
In Honor of
Birthday
Marriage
Wedding Anniversary
Get Well
New Baby
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Or name another occasion
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Name(s) of person(s) you are remembering
Please send notification of this donation to:
(The amount of your gift will be kept confidential.)
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First Name
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Last Name
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Address
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City, State and ZIP Code
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Country*
Comments:
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Please check your information for accuracy.
Contributions to Children's Hospital are tax deductible to the extent allowed under IRS guidelines.