FOUNDATION MEMBERSHIP/DONATION FORM
I/we support the WCGRH Foundation, Inc., established to enhance the services provided for the clients and staff of West Central Georgia Regional Hospital.
[ ] Enclosed is my annual membership fee in the amount of $10.00.
[ ] Enclosed is my contribution in the amount of $______________.
[ ] Enclosed is my Lifetime Membership fee of $100.00.
[ ] In addition to my contribution, I would like to share my time and talents. Please contact me about volunteer opportunities at West Central Hospital.
YOUR DONATION IS TAX DEDUCTIBLE AND GREATLY APPRECIATED.