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Donate Online

Your Personal Information:
Name:
(As you would like it to appear on the recognition Wall of Honor and correspondence)
Company:
Address:
City:
State:
Zip:
Email:
Phone:

Donation Amount:
$25
$50
$100
$250
$500
Other $

Many companies offer MATCHING GIFT programs and will double or triple your gift to qualified non-profit organizations like the Jersey Community Hospital Foundation. Please contact your company’s Human Resource department for details on making a matching gift.

Gift:

Person to notify of this gift:
First Name:
Last Name:
Relationship to person honored/remembered:
Address:
City:
State:
Zip:
Any additional information:

Allocation of Gift:
Program Designation:
Other:

I prefer that my gift remain ANONYMOUS with any publication or recognition.
Please sign me up to receive Jersey Community Hospital’s quarterly email NEWSLETTER to stay up to date on the latest hospital news, fundraisers, educational programs, and upcoming events.
Please send information on how I can SUPPORT Jersey Community Hospital through planned giving, donating a vehicle /boat, or in my will.
I am interested in VOLUNTEERING and would like to know about opportunities that are available to volunteer a few hours a week or per month. Please contact me by telephone, mail, or email.

Payment Processing
Name as it appears on your credit card.
First Name: Last: Name
Card Number: Expiration Date: CCV:


Jersey Community Hospital Foundation
400 Maple Summit Rd.
Jerseyville, IL 62052
618.498.8392