Froedtert West Bend Hospital Love Light Tree Donation Form

Love Lights is sponsored by Volunteer Services at Froedtert West Bend Hospital.

Honor someone special this season with a donation to Froedtert West Bend Hospital. Proceeds from the Love Light Holiday Trees provide important support for direct patient care and hospital department needs. Dollars raised also provide three annual scholarships for local high school students pursuing health care careers.

Please fill out this form to indicate who you are honoring with your online donation. Online donations are taken through a separate form.

$5 donation — One multicolored light in HONOR of someone, one light per name
$5 donation — One white light in MEMORY of someone, one light per name

Name

E Mail

Please use this e-mail address on the payment screen that comes up after you submit this form. We will use it to match this form to your donation.

Phone

Address

City/Town

State/Province

ZIP/Postal Code

Name(s) and Designation(s)

Please fill out the form below with the name(s) of the person or people you are honoring or remembering. Check the boxes below that apply and include contact information for anyone you would like to receive an acknowledgement of the honor.

$5 donation — One multicolored light in HONOR of someone
$5 donation — One white light in MEMORY of someone

Name	Multicolored Light $5	White Light $5	Military Honor	Send acknowledgement to	Address	City	State	Zip/Postal Code	Operations
Name	Multicolored Light $5	White Light $5	Military Honor	Send acknowledgement to	Address	City	State	Zip/Postal Code

more items

Click the word "Add" for additional lines - up to 20.

Total Donation

$ .00

Please note this amount as you will need it for the payment screen after you submit this form.

After submitting this form you will be taken to the online payment screen. In the "Designate My Gift To" field, select "10 Love Light."

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Donate

262-836-8075