Enloe Medical Center by HC12091407497

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									Board of                        Please print and mail to:
Directors
                                Emergency Services Foundation
Rick Barnett
  Mercy Medical Center          43 Hilltop Drive
Judi Beck                       Redding, CA 96003
  Community Representative

John Di Perry, Jr.
  Community Representative

Marilynn Estey
                                Donor Pledge Form
  RMC Foundation

David Herfindahl, M.D.          Donor: ________________________________________
  Siskiyou Co. Health Officer
Linda Leavell
  Redding Medical Center        Organization: ___________________________________
John Lord
  American Medical Response
Greg McFadden                   Title: __________________________________________
  Butte County Fire
Paul McGram
  Redding Rancheria/Win-River   Address: _______________________________________
Dan Neumeister
  Enloe Medical Center
                                City: _____________ State: ________ ZIP: __________
Shan Patterson
  Community Representative

Dan Spiess                      Phone: _________________ FAX: __________________
  Nor-Cal EMS

Molly Wilson
  Shasta Co. Board of
                                Pledge amount: ___________ Date of pledge __________
  Supervisors


                                Membership Levels
                                (Check appropriate level; circle amount)
Executive
Director
                                                         Individual         Corporation        Recipient
John Cannan
                                Level                    or family          or foundation      organization
                                                         (Annual minimum)   (Annual minimum)   (Annual minimum)
                                ________________________________________________________
                                   Major Sponsor           $2,500               $10,000            $5,000
                                   Platinum Member $1,000                        $5,000            $2,500
                                   Gold Member               $500                $2,500            $1,000
                                   Silver Member             $250                $1,000              $500
                                   General Member            $100                 $500               $250

                                Payments
                                 Payment included
                                 Quarterly payments (ESF will send reminders)



                                Confidentiality
   I do not want my name to appear in publications, correspondence
    or other materials that recognize Foundation donors.

								
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