Donate Now

YES! I accept your invitation to join the 1930 Club in support of Wilson Memorial Hospital's endowment fund.

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

Please begin my:

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:

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.