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Tax-deductible donation to support Good Shepherd Hospice.

Donor Information :
(*) Required Fields. Please provide either Personal Name or Business Name.

* Donor First Name:

* Donor Last Name:

* Donor Business Name:

* Email:

* Business Phone:

* Home Phone:

* Address:

Address 2:

* City:

* State:

* Zip Code:

Country:
Donation Amount:
 
Amount:
 $1000 $500 $250 $100 $72 $50 $36 $25
Other Amount:
My gift is given:
In memory of In honor of
(please print name):
 
Gift Designation:

For the Hospice Inpatient Center Fund

  To the Annual Fund
  Springtime Remembrance Appeal
  To the Family Bereavement Fund
 
Please send notification of this gift to:

First Name:

Last Name:

Business Name:

Business Phone:

Home Phone:

Address:

Address 2:

City:

State:

Zip Code:

Country:
   
We do not share our donor names with other organizations.



© Copyright 2006, Good Shepherd Hospice, A Member of Catholic Health Services of Long Island