Valley Medical Center | Step 1

My Gift (select one or enter an amount of $30 per heart using numbers only, no '$' character) 1 Heart—$30 1 Heart with Stand—$35 2 Hearts—$60 2 Hearts with Stand—$70 3 Hearts—$90 3 Hearts with Stand—$105 4 Hearts—$120 4 Hearts with Stand—$140 5 Hearts—$150 5 Hearts with Stand—$175 Other Amount ($)

Your Information

Are you—

Individual

Organization

First Name

Middle Name

Last Name

Suffix

Your Title

Organization Name

Organization Division

Address Line 1

Billing Address Line 2

City

State

Zip or Postal Code

Email Address

Phone

Mobile Phone

Work Phone

Work Extension

I wish to remain anonymous

Name of caregiver(s) you wish to recognize

Personal Message and/or Instructions

Please contact me about planned giving

We'd love to know a little about who our wonderful donors are. Please check the box(es) that define you.

Patient

Family or Friend of Patient

Friend of Valley Medical Center

VMC Staff

VMC Retiree

VMC Volunteer

Valley Medical Center, also known as Public Hospital District No. 1 of King County, is a 501(c)(3) organization. Our federal tax identification number is 91-6000986. You may print this receipt for your records. Valley Medical Center confirms that you have made this donation as a charitable contribution and that you may have received goods in return. Your net donation is tax-deductible to the full extent of the law. As tax laws vary by state and by country, please consult a tax professional regarding the deductibility of this donation.

Thank you for supporting a caregiver!

AttentionX