If you would like to make a contribution to the Great Plains Health Care Foundation, please print this page and fill out the information and mail to:

Great Plains Health Care Foundation
PO Box 366
Phillipsburg, KS  67661

This gift is made in honor of:______________________________

Your gift to the Great Plains Health Care Foundation
entitles you to be a member as follows:
    [ ] $1-$24 General
    [ ] $25-$99 Sustaining
    [ ] $100 and over Parton

Name:__________________________________________________

Address:________________________________________________

City/State/Zip:____________________________________________

Please make checks payable to:  Great Plains Health Care Foundation.
Contributions to Great Plains Health Care Foundation are tax deductible.

"Serving Others - Making A Difference!"

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Great Plains Health Alliance, Inc.

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