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Donation Form

 

Yes!

I want to help support the AMH Foundation!

 

 

This form cannot be electronically submitted. 

To support the Foundation, please print this form and mail it to:

 

Amsterdam Memorial Foundation

4988 State Highway 30

Amsterdam, New York 12010

 

Or fax us your pledge at (518) 841.

Name             

Address         

City                 

State               

Zip                   

E-mail             

Credit Card # 

Card Type             Card Expiration  

Signature       

    $250

    $100 

    $50 

    $25 

    Other   

    I will host a special fundraising event.

   I would like you to send a card to someone in honor of my donation to AMH.  Please send the card to:

Your contributions may be tax deductible.

Donations are intended for people with connection to AMH.  

Amsterdam Memorial Healthcare

4988 State Highway 30  ●  Amsterdam, New York 12010   ●  (518) 842-3100

 

This site is presented for information only and is not intended to substitute for professional medical advice.

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