Highline Medical Center Foundation

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for your support of the Foundation and your dedication to promoting health in our community! Your gift will help Highline Medical Center continue to provide the highest quality care to our patients and their families.

Please complete the form below. If you prefer, you can print the complete form and mail or fax it. Or you may call the Foundation with this information.

Highline Medical Center Foundation
16259 Sylvester Rd SW #101
Burien WA 98166
Phone: 206-901-8500
Fax: 206-901-8509

If circumstances change from when a donor makes a restricted gift and it is impossible, inappropriate or impractical to carry out the restricted purpose, the Foundation may re-designate the purpose of the gift to support Highline Medical Center in a manner that adheres as closely as possible to the donor’s original stated intent.

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Donation Amount

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Recurring Frequency:

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Donor Information:

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Phone (10 digits): *

E-mail: *

A receipt will be e-mailed to this address.

Are you a Highline employee?

Anonymous:

I wish to remain anonymous about my gift.

Gifts may be made in memory or in honor of someone special or in recognition of a special occasion. If your gift is in recognition or a memorial, please complete the sections below.

Please accept this gift:

Name:

Occasion:

Please acknowledge my gift to:

Name:

Address:

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Do you have Matching Funds available?

Company/Organization:

My employer matches charitable contributions.