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Donation Form
Donation Information
St. Mary’s Health Care System Foundation is a 501(c)(3) non-profit organization serving the communities of St. Mary’s Hospital-Athens, Good Samaritan Hospital-Greensboro, and Sacred Heart Hospital-Lavonia. Your gift is tax deductible to the full extent of the law. Donations may be given to a specific hospital’s service lines or to their area of greatest need. Thank you for your support!
Amount:
$
*
Designation:
SM Acute Palliative Services
SM Area of Greatest Need
SM Cardiac Services
SM Community Health & Wellness
SM Mission Services
SM Neuro Sciences
SM Orthopedic Services
SM Professional Growth & Development
SM Rehabilitation Services
St. Mary's Auxiliary
SM Women & Family Services
GS Acute Palliative Fund
GS Area of Greatest Need
GS Cardiac Services
GS Community Health & Wellness
GS Mission Services
GS Neuro Sciences
GS Orthopedic Services
GS Professional Growth & Development
GS Rehabilitation Services
Good Samaritan Auxiliary
GS Women & Family Services
SH Acute Palliative Services
SH Area of Greatest Need
SH Cardiac Services
SH Community Health & Wellness
SH Mission Services
SH Neuro Sciences
SH Orthopedic Services
SH Professional Growth & Development
SH Rehabilitation Services
Sacred Heart Auxiliary
SH Women & Family Services
Additional Information
Type of gift:
One-time gift
Recurring gift
Frequency:
Weekly
Monthly
Quarterly
Annually
Every 4 weeks
On:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Starting:
Ending:
Ending:
Corporate:
This donation is on behalf of a company
Anonymous:
I prefer to make this donation anonymously
Details / Notes about this gift:
Billing Information
Title:
Mr.
Mrs.
Miss
Ms.
Dr.
Drs.
Professor
Hon.
Pastor
Sister
Brother
Ambassador
The Reverend Dr.
Chief
Chaplain
Bishop
Congresswoman
Reverend
Congressman
Colonel
Major General
Father
Major
Lt. Governor
Cmdr.
Mayor
The Reverend
Judge
Rabbi
Deacon
Lt. Col.
The Honorable
Chaplain Col.
Captain
Governor
Senator
Sergeant
Mx.
First name:
*
Last name:
*
Country:
Afghanistan
American Samoa
Angola
Argentina
Australia
Austria
Bahamas
Belgium
Belize
Bermuda
Bolivia
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
China
China (PRC)
Colombia
Costa Rica
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
England
Finland
France
Germany
Ghana
Greece
Guam
Guatemala
Guyana
Honduras
Hong Kong
Hungary
India
Indonesia
Iran, Islamic Republic of
Ireland
Israel
Italy
Jamaica
Japan
Japan 141
Jordan
Kenya
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Lebanon
Liberia
Liechtenstein
Macedonia,The former Yugoslav Republic
Malaysia
Malta
Mexico
Monaco
Mongolia
Monte Carlo
Myanmar
N. Ireland
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Nigeria
North Ireland
Norway
NP Bahamas
Pakistan
Panama
Papua New Guinea
Peru
Philippines
Poland
Portugal
Puerto Rico
Romania
Russian Federation
Rwanda
Saint Lucia
Santo Domingo
Saudi Arabia
Scotland
Scotland, UK
Singapore
Slovenia
South Africa
Spain
Swaziland
Sweden
Switzerland
Taiwan, Republic of China
Tanzania, United Republic of
Thailand
Trinidad and Tobago
Turkey
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA
Viet Nam
Virgin Islands, U.S.
West Africa
*
Address:
*
City:
*
State:
<Please Select>
Armed Forces Americas
Armed Forces Europe/Canada/Middle East/Africa
Alaska
Alabama
Armed Forces Pacific
Arkansas
American Samoa
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Colorado
Connecticut
Canal Zone
District of Columbia
Delaware
Florida
Federated States of Micronesia
Georgia
GM
Guam
Hawaii
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South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
*
Zip:
*
Phone:
Email:
*
Confirm Email:
*
Tribute Information (Optional)
This gift is in honor or memory of:
*
This gift is in honor or memory of: (First name)
(Last name)
*
Tribute Type:
in honor of
in memory of
*
Description:
*
Mail a letter on my behalf to:
*