Please print this form and mail to: Charlevoix Area Hospital Foundation, 14700 Lakeshore Drive, Charlevoix, MI 49720, or fax to: 231-547-8658.
I wish to receive future email correspondence.
I prefer to make my donations anonymously.
The above amount is a Pledge Gift to be paid in the following manner:
$ annually $ quarterly
$ other (please detail)
Please remind me of this commitment:
Monthly Quarterly Annually
Fill in below only if different from the information above.