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- In support of the Cook Hospital - |
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YES, I'D LIKE TO SUPPORT THE W.C. HEIAM MEDICAL FOUNDATION
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Enclosed is my/our gift of (circle):
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$25 | $50 | $100 | $250 | $500 | $1,000 | $2,500 | Other |
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This gift is in memory of:
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Please send acknowledgement of gift to:
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YOUR NAME(S):
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ADDRESS:
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Please make checks payable to: W.C. HEIAM MEDICAL FOUNDATION
Send to: P.O. Box 1195, Cook, MN 55723
THANK YOU!