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Gift and Tribute Form

To make a gift to Children's Hospital and Health System, please fill in the form below (fields with a red asterisk are required). Tribute Gifts of $25 or more are listed in the hospital's publication, "Children's Hour", published three times a year. Payment can be made either online with your credit card, or you can simply print this form and mail it, along with your contribution, to:

Children's Hospital and Health System Foundation
Mail Station 3050
P.O. Box 1997
Milwaukee, WI 53201

We do not sell, exchange or otherwise distribute names or email addresses of our donors for solicitation or marketing purposes.

Title:

First Name:

Middle Initial:

Last Name:

Address:

Apt./Suite No.:

City:

State:

Zip:

Telephone:

( )

E-mail:

Pledge your support:

Single payment of $
OR
Monthly payment of $

Gift Designation:

Other Gift Designation:

Tribute:

In Honor of

Person's First Name:
Person's Last Name:
Occasion:

In Memory of

Person's First Name:
Person's Last Name:

Please acknowledge my gift with the appropriate tribute card to:

Name:
Address:
City:
State:
Zip:

Type of Credit Card:

Credit Card Number:

Expiration Date:

CVV2:

Lock You can safely enter your credit card number via our secure server, which encrypts all submitted information.

At Children's Hospital we have taken measures to ensure the safety of your credit card use on our site.

Our secure server software (SSL) encryption is the industry standard and among the best software available today for secure commerce transactions.

This encrypts the credit card numbers and all of your personal information so that it cannot be read as the information travels over the Internet.

Children's Hospital and Health System Foundation
Milwaukee office: (414) 266-6100
Appleton office: (920) 831-6400


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