Love Lights Form | Froedtert Menomonee Falls Hospital

Honor someone special this season with a donation to Froedtert Menomonee Falls Hospital. Proceeds from Love Lights benefit patient care services, allowing the volunteers to give back over $100,000 annually to the hospital.

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

$10 donation – One light, one name honored
$50 donation – String of lights, up to six names

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.

Red Lights – in honor of someone
White Lights – in memory of someone
Military Honor
$10 donation – One light, one name honored
$50 donation – String of lights, up to six names

Name	Light $10	String $50	Red	White	Military Honor	Send acknowedgement to	Address	City	State	Zip/Postal Code	Operations
Name	Light $10	String $50	Red	White	Military Honor	Send acknowedgement 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.

CAPTCHA

Froedtert Menomonee Falls Hospital Love Lights Form

Name(s) and Designation(s)

Total Donation