Valley Medical Center | Step 1

My Gift $300 Tribute Package Other Amount ($)

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Your Contact Information

Enter credit card billing information below.

The keepsake heart and tax receipt will be mailed to this address. Please provide any special delivery instructions in the "Personal note" field at the bottom of this form.

Your Contact Information

Enter credit card billing information below.

The keepsake heart and tax receipt will be mailed to this address. Please provide any special delivery instructions in the "Personal note" field at the bottom of this form.

Are you—

Individual

Organization

First Name

Middle Name

Last Name

Suffix

Title

Organization Name

Organization Division

Address Line 1

Address Line 2

City

State

Zip or Postal Code

Email Address

Phone

Mobile Phone

Work Phone

Work Extension

This gift is also credited to my spouse or partner

Spouse/Partner Prefix

Spouse/Partner First Name

Spouse/Partner Middle Name

Spouse/Partner Last Name

Spouse/Partner Suffix

Spouse/Partner Email

Name(s) for Recognition

Provide your tribute details below.

Is this tribute made in honor or memory?

To whom would you like to make this tribute?

Would you like us to send an acknowlegement?

Yes, please mail the commemorative heart and my personal note to the party named below:

Notification Name

Address 1

Address 2

City

State

Zip

Personalization and Delivery Instructions

Enter a personal message for the note card. If you choose not to have us mail an acknowledgement, we will send the card and both hearts to you. Don't forget to include any special delivery instructions!

Personalization and Delivery Instructions

Enter a personal message for the note card. If you choose not to have us mail an acknowledgement, we will send the card and both hearts to you. Don't forget to include any special delivery instructions!

Personal Message

I wish to remain anonymous

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.

Tribute Gift Form

Thank you for your generous donation.

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