Donation Form | Laurel Health System

Laurel Health System encourages you to help ensure that everyone in your community has access to important health education, community programs, and quality health care. When you donate to Laurel Health System, your contribution makes a lasting and tangible change in the lives of your neighbors, friends, and family.

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Donation Form

Yes! I would like to support Laurel Health System!
You may use this form to pay by check or by credit card. (Click here for printable version)

Choose one of the following donation options:

Good Samaritans of Laurel Health
Charitable Gift Annuities
Annual Laurel Health System Pro-Am
Friends of Laurel Health
Helping Hands

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Amount

Your Name
Address
City
State
Zip
Phone
Fax
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Comments

If you would like to recognize someone through this donation, please select the type of gift and enter that person's name:


If you wish to notify someone of your donation, please enter their contact info:
Name
Address
City/State/Zip

	Laurel Health System • 22 Walnut Street • Wellsboro, PA 16901 • 800-808-LAUREL (5287) © Laurel Health System