Gift
Form
| Date_____________________ |
| If this a gift:
q In Honor of or q In Memory of |
| _______________________________________________________ |
| Occasion________________________________________________ |
| q My check
is enclosed. q
Enclosed is a matching gift form. q Please send me information about how planning a gift to Schneider Children's Hospital can provide a lifetime of income or reduced estate taxes. |
| q Please
charge ($25 minimum)
q Master Card q Visa q American Express |
| Account #_______________________________________________ |
| Exp. Date________ Signature_______________________________ |
| Your Special Message: (please print)_________________________
_______________________________________________________ _______________________________________________________ _______________________________________________________ |
| Phone # ( )__________________________________________ |
| Donor's Name(s)_________________________________________ |
| Address________________________________________________ |
| City______________________ State______ Zip________________ |
| If this is a gift, please send an acknowledgement card to: |
| Name__________________________________________________ |
| Address________________________________________________ |
| City______________________ State______ Zip________________ |
| Mail to:
North Shore-Long Island Jewish Health System Foundation 125 Community Drive Great Neck, New York 11021 |
| Fax to: (516) 465-2598 |
| Phone: (516) 465-2550 |