Yes! I Would Like To Be A Partner In Community Wellness!
Please accept this heartfelt gift to Kent & Queen Anne's Hospital

Payment Method: (Please check one)
Visa
Mastercard American Express
Discover Card

Gifts of securities, real estate, and life insurance are also welcome.
Please call (410) 778-3300 ext. 4070 for transfer instructions.


Gift Amount
$5,000 $1,000 $500
$250 $100 other Amount of $

Card Number:  No spaces or dashes please
Expiration Date:  (MM/YYYY)

Name:
Street:
City: State:
Zip:

Phone: E-mail:


You may use my/ our name for recognition purposes.
No
Yes

My/Our birthdate(s) (Optional)  Mine
 Spouse (if applicable) 

Don't forget - you can double your gift if your company has a matching gifts program!

Your gift is tax deductible. Federal ID 52-0679694

My/our gift is:
I/ we would like to designate
my/ our gift for:
In memory of:
In honor of:
Please send an acknowledgement card to:
Where needed most
Equipment
Building
Cancer Endowment
Other (please specify)
I/We have made a gift to Kent & Queen Anne's Hospital in my/our will.
I/We would consider making a gift to Kent & Queen Anne's Hospital in my/our will.
Please send me additional information about:
Estate & Financial Planning Annual Golf Tournament Volunteer Opportunities
We welcome your comments and suggestions:
Your contribution is 
   secured through: 

If you have any questions, please contact
Maryann Ruehmund
Kent & Queen Anne's Hospital Foundation
100 Brown Street.
Chestertown, MD 21620
(410) 778 - 3300 extension 4070



Or for more information, contact the Foundation at foundation@chesterriverhealth.org