I am proud to support the medical home of CHS!

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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