Our Gift Form

Please make check payable to:
Marias Medical Center Foundation
P.O. Box 915 • Shelby, Montana 59474

Enclosed is my gift of $____________________

Name:__________________________________________________________________

Address:___________________________ City:_________________________________

State:_________________ Zip:________________

Phone Number:__________________

My gift is given
O In memory
O honor of :______________________________________

Please use my gift
O Where most needed
O As specified:________________________

Please notify the following of my gift:

Name:__________________________

Address:________________________________

City:___________________ State:_________________ Zip:_____________

Gifts of any size are gratefully accepted. Your gift is tax-deductible.
Your check is your receipt.

Marias Medical Center Foundation
406-434-3239
mmcfound@3rivers.net