Ways to Participate - Become a Patron

Become a Patron Helping Hands patrons participate in all aspects of the Helping Hands fundraiser except for the Raffle component.
First Name
Last Name
Home Address
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Corlina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP code
Home Phone
Daytime/Work Phone
Email Address (home preferred)
Your LHS department or service	(LHS employees only)

I want to become a Helping Hands patron at a donation level of $200.

---

Please select from the following payment methods: Cash/check for full amount of $200. Make checks payable to Laurel Health System. 4-payment billing ($50.00 every 10 weeks). First payment should be made before March 27, 2009. We will invoice you for the remaining payments. Make checks payable to Laurel Health System. (LHS employees only) Payroll deduction of $8.00 per pay for a total deduction of $200, beginning with pay period ending April 2, 2009. N/A

---

Please automatically renew my Helping Hands ticket each year using the payment method indicated above, until/unless I notify you otherwise.

I would like the following commitee member to contact me:	Not Sure Missy Bleggi Teresa Bonk Lori Deitrick Gordie Dunlap Carrie English Pam English Joyce Fleming Kathy Gee Julie Glover Kathy Kramer Teresa Mengee Helene Messineo Jane Monks Linda Patterson Terri-Ann Scott-Knecht Barb Strope Barb Vandegrift Jackie Walker

Comments/Questions: