Charles Cole Memorial Hospital
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History of Philanthropy

Heart of Cole Employee Giving Club

Memorial & Honor Gifts

Annual Appeal

Donate Online

Contact Us
Donation Form (*Required)

First Name*:

Last Name*:

Email*:

Address*:

City*:

State*:

Zip*:

Day Phone*:

(Phone number will only be used to contact donor if there are questions regarding this donation)

I/We would like to make a gift of (Note: At the end of this form, you will be prompted to make your online payment via our secure connection with Paypal):
$5,000 $1,000 $500 $100
$50 $25 Other:

I do not wish to be listed in publications


All gifts, donations and bequests are tax deductible as allowed by Federal regulations.
If desired, select a category that you would like your donation to be used for:

or type in another need:



OPTIONAL FIELDS
In memory of:
Name:

In honor of:
Name:
Occasion:

Please send acknowledgement of my donation to:
Name:
Address:
City:
State: Zip:
(The amount of your gift will be omitted)
Please enter the below text*:
(lower case letters with 2 numbers)


Note: The final step includes an online donation button to complete your financial transaction through Paypal or you may send a check to the address in the next step.


More information about Fund Development is available by calling the Development Office at the Hospital at 814-274-5520.

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