Works of Mercy pledge form

mercy.net

Works of Mercy pledge form

Works

of Love

Mercy Health Foundation

401 Woodland Hills Blvd.

Fort Scott, KS 66701

SCT_25911 (6/27/13)


Works

Just one way Mercy Hospice

patients benefit from your

contribution is through the

Mercy Wishes program.

Here’s just one story:

As a former drag racer, Roger Griffith’s love for

the smell for burning rubber goes way back.

However, with cancer slowly consuming his

body, he thought the chance to feel the power of

a NASCAR had come to a screeching halt.

But with over 40 family members and friends

cheering him on, Roger’s life-long dream came

true. As a recipient of the Mercy Wishes

program, he was able to take part in the Richard

Petty Driving Experience at Kansas Speedway.

“None of this would have been possible without

the Mercy Hospice team,” said Chris Middleton,

Griffith’s daughter.

Mercy Hospice is designed to assist the patient

and their family in preparing for another part

of life’s journey,” explained Wanda Ogle, RN

with Mercy Hospice. “Roger was able to live his

dream surrounded by family and friends. That

is exactly how one should want to complete

their life.”

You too can make a dream come true, assist

with medical supplies not covered by insurance,

personal supplies such as Bibles or bereavement

services for Mercy Hospice patients by making

a donation.

Please fill out, detach and return to Mercy Health Foundation.

of Love

2013 Pledge Form benefiting Hospice

Enclosed is my gift to the Works of Love campaign for the Mercy Wishes program:

m $25 m $50 m $100 m $500 m $1,000

m Other ________

m Check enclosed, made payable to Mercy Health Foundation Fort Scott

m Credit card number __________________________________________ Exp. Date ___________

m Amex m Discover m MasterCard m Visa

Signature __________________________________ Three Digit Security Code __________

Online gifts are accepted at mercy.net/fortscottks/giving

Recognition Information

m In Honor Of ____________________________________________________________________

m In Memory Of __________________________________________________________________

(Please provide preferred information for recognition on our Foundation website.)

MAIL ACKNOWLEDGEMENT LETTER TO:

Name______________________________________________________________________________

Address ___________________________________________________________________________

City __________________________________________ State _________ Zip ________________

Donor Information

Name______________________________________________________________________________

Email _______________________________________ Daytime Phone ________________________

Organization _______________________________________________________________________

Address ___________________________________________________________________________

City __________________________________________ State _________ Zip ________________

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