TO REMEMBER SOMEONE WITH A MEMORIAL GIFT OR A GIFT OF HEALING AND CARE

Dear Friend,
Your gifts to the Belmond Medical Center Auxiliary can touch so many lives in Belmond and the surrounding service area. Thank you for your support.

To make a gift to the Belmond Medical Center Auxiliary, please print the following form and mail to:
Belmond Medical Center Auxiliary
403 1st St. S.E., Belmond, Iowa 50421

Name:__________________________________
Address:________________________________
City:______________________ State:____________ Zip:___________

Enclosed is my gift of________________
(Payable to Belmond Medical Center Auxiliary)

General Gift____ OR Specific Purpose____

(Optional)
In Memory Of:____________________________

In Honor Of:______________________________

I would like someone to contact me concerning a gift to the Belmond Medical Center Auxiliary.
My phone number is:____________________