Annual Campaign

Note: The form below is a printer-friendly version. You may complete it online, then print it for mailing, or you may print the form and fill it out in pen before mailing.

YES, I want to support

THE POTTSVILLE HOSPITAL AND WARNE CLINIC
ANNUAL CAMPAIGN

with my tax-deductible* gift in the amount of:

$1000 Other

Please make checks payable to:
The Pottsville Hospital and Warne Clinic

Please send your donation to:

Attn: Development Office
The Pottsville Hospital and Warne Clinic
420 S Jackson St
Pottsville, PA 17901-9957

I am interested in Planned Gift opportunities.
I am interested in volunteering opportunities.

Your contribution will help insure the success of ongoing projects at The Pottsville Hospital and Warne Clinic:

- Intensive Care Unit -
(completed 12/03)

- Telemetry - Progressive Care Unit -
(completed 12/03)

- Inpatient Rehabilitation Unit -
(scheduled for completion 6/04)

Need more information? Please call Leslie Wagner at 570-621-5141

Name:
Address:
City: State: Zip:
Phone:
E-mail Address:

The official registration and financial information of The Pottsville Hospital and Warne Clinic may be obtained from the Pennsylvania Department of State by calling toll free within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement. If you do not want to receive future mailings from the Development Office, please call 570-621-5141.

*Please consult with your tax consultant or financial planner.