Donate Online

Donate Online

Please use the secure form below to make your donation to support the CMH Foundation or the CMH Auxiliary. Thank you for supporting Community Memorial Hospital.

 


Donor Information:

Donor Name:
Address:
City:
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Zip:
Phone:
Email:

Donation Information:

Total Gift (choose one):
$1,000
$3,000
$5,000
$10,000
$25,000
Other $
I designate my donation to be used as indicated below:
• Please indicate how you would like your name displayed in any donor recognition for this gift
(i.e. John & Susan Smith, Smith Family, Susan Smith):


Additional instructions for my gift:

Memorial given in memory/honor of:
First Name:
Last Name:
 
I would like an acknowledgement to be sent to the person/family honored at the address below.
Address:
City:
State:
Zip:

I prefer to remain anonymous.
I would like more information on Estate Planning.
  Special instructions/note about the gift:

Billing Information:

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Name as it appears on your credit card.
First Name: Last Name:
Card Number: Expiration Date: CCV:

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208 N. Columbus | Hicksville, OH 43526 | (419) 542-6692

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