GIFT CARD

Use this gift card to send in a donation today to help support Morrill County Community Hospital and Morrill County Hospital Foundation.

Name: ____________________________________

Address: ____________________________________

City: _____________________   State: ____   Zip: __________

In support of Morrill County Hospital's Foundation,

Please accept my gift of _____________ or pledge of ________________

to be paid over _____ years starting (month) __________ (year) _________

Signed: __________________________________   Date: ______________________

Please bill:  ___ Annualy       ___ Semi-annualy        ___Quarterly

Other: ________________________________________________________

I'm interested in payroll deduction from my company.

Company Name: _______________________________________________

Address: _________________________________________

City: _______________________________   State: _____   Zip: ___________

For Office Use Only

Pledge:           _______________

Paid now:     _______________

Balance:         _______________

All gifts are fully deductible.

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To ensure confidentiality, please send this pledge in an envelope to:

Morrill County Hospital Foundation

PO Box 75

Bridgeport, NE  69336

Thank you from Morrill County Hospital Foundation.