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Please
accept my/our pledge of $ ______________
All
pledges to A Plan to Expand can be made over
A
three year period.
I
will send a check:
$
________ Quarterly
$ ________ Semi-Annually
$
________ Annually $
________ Other
_____
Please send a reminder when payment is due.
Name
____________________________________
Address
__________________________________
City
_____________________________________
State
_____________ Zip
___________________
Email
____________________________________
Phone
____________________________________
Signature
______________________ Date _______
Your gift is tax deductible subject to IRS regulations. |
My
gift is:
In
honor of ________________________________
In
Memory of ______________________________
Please
notify the following of my gift:
Name
____________________________________
Address
__________________________________
City
_____________________________________
State
__________________ Zip
______________
Please
make checks payable to:
MCH
A Plan to Expand.
121
Drew Avenue SE
A plan to
Madelia,
MN
56062
expand
507-642-3255
Madelia
Community Hospital
Thank you for your gift!
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