DONOR INFORMATION
 
 
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Gift Designation
Select an Area of DesignationDiabetes EducationDialysis CenterHomeCareHospice of the Big HornsMembership (Annual Gift)Memorial or Honor GiftNursing Scholarship EndowmentPatient ExperiencePediatric UnitTransitional Care UnitUnrestricted (Board Directed)Welch Cancer CenterOther
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Title
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Main Phone Number
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Email
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Yes, I would like to receive
free monthly e-mail updates
from Sheridan Memorial Hospital
and the Foundation:
Yes
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DONATION DETAILS
 
 
 
This Gift is being made
in Honor of 
 
 
in Memory of
 
 
Gift of Kindness in honor of staff member:
 
 
 
 
Yes, I would like the family or individual
to be notified of my gift at the following address
Name
Address
Address
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State
Zip
 
 
I prefer to make my
donation anonymously
No
Yes
 
 
ADDITIONAL INFORMATION
 
 
 
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