The Children's Healing Institute | Make an Online Donation

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PARTNERS

I want to help The Children’s Healing Institute in Palm Beach and Broward counties. Please enroll me in the following donor category and place me on your mailing list.

Donor Level
	$1,000	$500	$250
	$100	$50	Other $
	Please keep my gift anonymous.
Mr. Ms. Mrs.

Name:
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City:

State:

Zip Code:

Phone:		Fax:
Email:
Your phone number will only be used if we need to clarify any information on your donation form. It will not be used for solicitation purposes.

Method of Payment

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Credit Card Billing Address is the same as the
Registration address. If not, please enter the billing address below.

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Memorial or Honorary Donations
This gift is in	honor memory	of .
Please notify the following person that I have made a gift in the honor/memory of the person noted above. I understand the amount of my gift is not mentioned in the letter.

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If you prefer to pay by check, please download the donation form and mail it with your check to the address on the top of the form.