Boone County Hospital Gardens Donation Form
"The Gardens" of Boone County Hospital
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Yes, I/we would like the opportunity to create a lasting gift by making a donation of $50 for an inscribed garden brick.
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I/we do not wish to purchase a brick. However, I would like to make a donation to "The Gardens" of Boone County Hospital in the amount of:
____ $50 ____ $100 ____$500 or Other $__________
Please Print or Type
Name(s) _________________________________________________________________
Address__________________________________________________________________
City_________________________________ State_______ Zip Code________________
Phone (Daytime)__________________________ Evening_________________________
Enclosed is my check made payable to Boone County Hospital Foundation in the amount of:
$___________
Name, date, or message to be inscribed: (15 characters per line. Spaces between words are also characters.)
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Would you like us to notify someone of your gift? Please provide his or her name and address below!
Name ____________________________
Address
____________________________________
____________________________________
QUESTIONS? CALL THE FOUNDATION OFFICE AT 433-8470.
Please Send Completed Form To:
Boone County Hospital Foundation
1015 Union Street
Boone, IA 50036