Milford Regional Medical Center Milford Regional Medical Center
Development Office
14 Prospect Street, Milford, MA 01757
508-422-2228
Fax: 508-634-9124

Enclosed is my gift of:  (  ) $35   (  ) $50   (  ) $100    (  ) Other $________

 

Name _____________________________________________________________

Address ___________________________________________________________

Town _________________________________ State _________Zip ___________

Phone Number ______________________ Email Address ____________________

In Memory of _______________________________________________________

In Honor of ________________________________________________________

Please acknowledge this gift to:

Name _____________________________________________________________

Address ___________________________________________________________

Town _________________________________ State _________Zip ___________

Charge my credit card:   (  ) MasterCard   (  ) Visa   (  ) AmEx   (  ) Discover

Card Number _____________________________ Expiration Date _____________

Signature __________________________________________________________

Please make your check payable to Milford Regional Medical Center.

All gifts are tax deductible to the extent provided by law.

Please send me the following information on the hospital:

____ Annual Report

____ Focus Newsletter

____ Giving through my will

____ Provider Directory

____ Community Education Programs

Other _____________________________________________________________