Printable Donation Form

To make a donation, you can fill out this form, print it from your browser, and submit it to:
Lewis County Hospice
PO Box 266
Lowville, NY 13367

Name      
Address  
                

Enclosed is my gift of $

My gift is in loving memory of   
                              or in honor of 

My gift is a contribution to the Friends Forever Fund in the amount of $

Total amount of gift $

Please notify the following of my gift:
Name     
Address 
                

My employer, , will match my gift.  I will initiate this procedure right away.

Please make checks payable to:
Friends of Lewis County Hospice

All contributions qualify for a Federal Income Tax Charitable Deduction.
Your entire contribution will go directly toward patient care.
Thank you for your support.