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Your Health Services
Foundation represents a hefty portion of generosity,
determination
and commitment to a
greater cause spanning several generations.
Your gift to the Foundation will assure that many worthy
healthcare projects will receive
our support because of your willingness to “Care and
Share”.
Gifts may be made payable to:
Health
Services Foundation
PO Box 1231 • Houlton, ME 04730
If you would like your contribution specifically
designated, please indicate below:
Foundation Endowment Fund
Nuclear Medicine Campaign
Pediatrics Facility Support
Mammography Unit
Boy and the Boot Statue*§
The Center for Community Health Education§
VISA / MasterCard / American Express accepted, please
call with your information.
For further information on projects made possible by
your support, please write to the above address or phone
us
at 207-521-2147 or 521-2503. Our office will be happy
to assist you with any questions you may have.
Name:___________________________________________________________________
Address:__________________________________________________________________
________________________________________________________________________
Tel.#:____________________________________________________________________
Signature:_________________________________________
Date:_____________________
Pledge:___________________
Payment:
_________________
Balance:_________________
Payments are to be made on an
________
annual,
______
semi-annual, or
_____
quarterly basis beginning
______,
or as follows: _______________________________________________________________
*Your pledge can be represented in three different ways:
with Your Name or as a Family (keep in mind space
is limited for several individual names) as a Business,
“In Memory” of someone or as an Anonymous Donor.
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