Here is my gift of:
____$25 ____$50 ____$100 ____$500 ____$1,000 ____Other $_________

Donor’s Name_______________________________________________________

Address_______________________________________________________

City ________________________________________

State_______________ Zip _____________

Phone (_____)__________________________

E-mail____________________________________



If paying by check, please make your check payable to Delta Health Foundation, Inc.
Please fill out this form and mail, with donation, to:
Delta Health Foundation, Inc.
7401 Delta Lane
Charlotte, NC 28215

Delta Health Foundation is a 501(C)(3) charitable organization. Contributions to Delta Health Foundation are tax deductible to the full extent allowed by law. To control expenses, the Foundation will send receipts for gifts of $25.00 or more.
___My employer has a matching gift program; please send me information on how to double my gift.
___I’m interested in automatic monthly, quarterly or semi-annual giving; please send me more information.