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Street Address: _____________________________________________________________ City/State/Zip: _____________________________________________________________ Card Holder Signature: ________________________________________________________ Enclosed is my contribution of: Visa or Master Card Number:_____________________________________________________ Please visit our website for a safe, secure, and easy donation page I wish to remain anonymous I am aaliated with a matching gift company
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I am proud to support the medical home of CHS!
$25 $50 $100 $250 $500 $1,000 Other __________
Gifts to Child Health Services are tax-deductible within the limitations of the federal income tax law. CHS is a 501(c)(3) non-pro�t organization.
Please visit our website for a safe, secure, and easy donation page
www.childhealthservices.org
Enclosed is my contribution of:
Name: __________________________________________________________________
Street Address: _____________________________________________________________
City/State/Zip: _____________________________________________________________
Phone: (W)_______________ (H)_____________________(C)______________________
Visa or Master Card Number:_____________________________________________________
Amount:_______________________________________Exp. Date ____________________
Card Holder Signature: ________________________________________________________
I would like to receive CHS e-mail updates, my email is: _________________________
I am interested in becoming a Child Advocate for an annual pledge of $1,500
Apply this contribution to my prior pledge
Please send me information on planned giving opportunities
I wish to remain anonymous
I am a�liated with a matching gift company
Please contact me regarding volunteer opportunities at CHS