Contribution Form If you would like to mail a gift instead of giving online, please complete this form and send with your payment to: Mary Greeley Medical Center Foundation 1111 Duff Avenue Ames, IA 50010 *Required information *Date: 12/27/2009 *Name of contributor(s): *Address: *City: *State: *Zip: *Phone: *E-mail: Enclosed is my gift of: $10 $25 $50 $100 $250 $500 $1,000 Other: Method of payment: Check Enclosed (payable to MGMC Foundation) Credit Card Discover Credit Card information: Visa MasterCard American Express Card Number: Expiration Date: Name as it appears on card: Cardholder Signature:_____________________________ I/We wish to make a gift of property: stocks/securities real estate other: *Gift Designation: Please apply my gift to the following: Area of Greatest Need Diabetes and Nutrition Education Center Cancer Resource Center Israel Family Hospice House Other (please specify): Memorial and tributes (optional) This gift is in memory of: This gift is in memory of: Please send acknowledgement to: Name: Address: City: State: Zip: My/our gift will be enhanced by a matching gift from the following company: I/we have included MGMC Foundation in my/our will I/we wish to learn more about how to make a deferred gift to the MGMC Foundation and become a member of the Greeley Society We welcome your comments about your gift and your inspiration to give: Mary Greeley Medical Center Foundation is a nonprofit 501(c)(3) charitable organization and contributions are tax deductible to the extent allowed by law. Contributions support programs in patient care, medical education, special equipment and services which assists Mary Greeley Medical Center in providing specialized care with a personal touch. For more information, contact the MGMC Foundation office at 515-239-2147.
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