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Your donation today will help Holy Family Memorial provide services to help individuals and our communities achieve healthier lives.

Please complete the following (All * marked fields are required.):


Section I
* At this time I/We would like to donate $ to Holy Family Memorial.

*My gift is given through the following campaign:

Please contact me to talk about having my donation automatically withdrawn from my checking account on an ongoing basis.

I wish my gift to benefit:

If Other:

This gift is restricted for:
* This gift is made:

Please notify:
City State Zip

*Relationship to person being notified:
*Please send me a receipt
*Please send me information about including Holy Family Memorial in my will or estate plans.
*Please contact me about contributing stock to Holy Family Memorial.  
*My has received services at Holy Family Memorial

If your company will match your gift, please mail the necessary forms to:

Holy Family Memorial
Attn: Fund Development
600 York Street
P.O. Box 1450
Manitowoc, WI 54221-1450

Personal Information:

Section II (must be completed)
*Title *First Name MI *Last Name Suffix
*Street Address

Address 2

*City *State *Zip
*Home Phone Business Phone
   (xxx) xxx-xxxx (xxx) xxx-xxxx
*Email Address

Giving Options:

Section III
*Please charge my/our
*Print name as it appears on card
*Card Number
(no dashes - or spaces)  
*Expiration Date (month/year)

*CID# (3 digit code on back of card):  


Section III (Check or Money Order made payable to Holy Family Memorial)

* Enclosed is a

If you have any questions, please call Holy Family Memorial at (920) 320-6583