Gift Form

To Give a Gift of Healing and Care

Dear Friend, 
Your gift to the FGH Foundation will touch so many lives in the Franklin County service area. 
Thank you for your support.

To make a gift to the FGH Foundation, please print the following and mail to:

Franklin General Hospital Foundation 
1720 Central Ave E 
Hampton, IA 50441

Name:________________________________________________________________________________________________

Address:______________________________________________________________________________________________

City: ___________________________________________  State: __________________ Zip: ________________________

Enclosed is my gift of: $________________________________________________ (Payable to FGH Foundation)

(Optional) 
In Memory Of: _______________________________________________________________________________________

In Honor Of:__________________________________________________________________________________________

I would like someone to contact me concerning a gift to the Franklin General Hospital Foundation. 
My phone number is: _________________________________________________________________________________