Annual Appeal 1930 Club | Wilson Hospital Foundation

Bronze $100 - 249

Copper $250 - 499

Pewter $500 - $999

Silver $1,000 - $2,499

Gold $2,500 and over

Amount:

Please accept my outright gift above

Payroll deduction in the amount above per pay period AND/OR hours of MTO to be deducted annually in October

Gifts in amounts below $100 will be appreciated, but will not be included in the 1930 Club listing.

(NOTE: Donations through payroll deduction or MTO will continue until you notify us to make a change and either increase, decrease or stop the gifts.)

Please print or type how you wish your name(s) to appear on the membership list:

Name:

Department:

Address:

City:

State:

Zip:

Email:

Please list this gift anonymously.

If you wish to make an annual donation by check, please make it payable to: Wilson Memorial Hospital Foundation - 1930 Club and returned with this form, or click the button to the right to donate now.