Caring Circle/Lory's Place Annual Appeal

I will support Caring Circle and/or Lory's Place programs

$1.00 - $999.00 – All gifts designated to Caring Circle
are appreciated, no matter what the amount.

$1.00 - $999.00 – All gifts designated to Lory’s Place
are appreciated, no matter what the amount.

Care Club - $1000 or more toward the Caring Circle Annual Appeal

Beacon Club - $1000 or more toward the Lory's Place Annual Appeal

First Name *

Last Name *

Email Address

Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Country

Phone Number *

In Memory / In Honor of

Occasion

Address of Honoree

Relationship

Please designate my gift to: *

Donation Comments

Hospice at Home / Lorys Place is a 501 C-3 organization; all donations are tax deductible as permitted by law

TERMS of AGREEMENT: My authorization to charge my credit card shall remain in effect until I notify Hospice at Home by mail, phone or e-mail that I wish to end this agreement and Hospice at Home has had a reasonable amount of time to act on my request. A record of each payment will be included on my credit card statement and will serve as my receipt.

We use an online payment processing service called "Paypal" to SECURELY process payments, but YOU DO NOT have to have a Paypal account in order to submit payment. Once directed to the Paypal site, just follow the directions for users without paypal accounts.