Complete the appropriate information below to make a Standard Donation, or to participate in our Pediatric Facility Naming Opportunity fund-raiser.

Standard Donation:

I would like to make a gift of $ to the Greater New Bedford Community Health Center's (check one):

Operational Campaign

Capital Campaign

My gift is to be paid as follows:

Please send reminders (check one):

Quarterly     Annually     Don't send reminders

Email:

Telephone:

Company matching gift (check one)? Yes     No

Pediatric Facility Naming Opportunity:

The GNBCHC is offering naming opportunities in our new pediatric facility. A variety of donation levels are available to individuals and organizations. If you would like a a naming opportunity, please complete the appropriate fields below:

Exam Table $1000 — Dedicated to (enter person's name):
Nurse's Station $3000 — Dedicated to (enter person's name):
Exam Room $5000 — Dedicated to (enter person's name):
Reception Area $8000 — Dedicated to (enter person's name):

Please charge my credit card (check one): MasterCard     Visa     Discover

Card #:     Expiration Date:

Name on Card:

Address:


City:    State:    Zip:


Comments/Questions:


Today's date:

Click below to submit your contribution: