Laurel Health Helping Hands Participate Form

Two Ways to Participate

You can participate in the Helping Hands fundraiser by buying a ticket or becoming a patron.
Purchase a Ticket
First Name
Last Name
Home Address
City
	State Zip
Home Phone
Daytime/Work Phone
E-mail Address (home preferred)
Your LHS department or service	(LHS employees only)
I want to purchase a 2008-09 Helping Hands Raffle Ticket at a total cost of $200.
Please reserve my ticket number from last year''s Helping Hands Raffle (cut-off date is June 9).

Please select from the following payment methods:
Cash/check for full amount of $200. Payment should be made before June 16, 2008. Make checks payable to Laurel Health System.
4-Payment billing ($50 every 10 weeks). First payment should be made before June 16, 2008. We will invoice you for the remaining payments. Make checks payable to Laurel Health System.
(LHS employees only) Payroll deduction of $10 per pay for a total deduction of $200, beginning with pay period ending June 12, 2008.
(Sorry -- don''''t click here!)

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 committee member to contact me:
Comments/Questions:

Thank you for your ticket purchase!



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 Zip
Home Phone
Daytime/Work Phone
E-mail Address (home preferred)
Your LHS department or service	(LHS employees only)
I want to become a Helping Hands patron at a donation level of $150.

Please select from the following payment methods:
Cash/check for full amount of $150. Make checks payable to Laurel Health System.
4-payment billing ($37.50 every 10 weeks). First payment should be made before June 16, 2008. We will invoice you for the remaining payments. Make checks payable to Laurel Health System.
(LHS employees only) Payroll deduction of $7.50 per pay for a total deduction of $150, beginning with pay period ending June 12, 2008.
(Sorry -- don''''t click here!)

Please automatically renew my Helping Hands patronage each year using the payment method indicated above, until/unless I notify you otherwise.
I would like the following committee member to contact me:
Comments/Questions:

Thank you for your patronage!
To celebrate the many wonderful ways in which your donation will help Laurel Health System serve our local communities, you are cordially invited to the Helping Hands Gala to be held March 21, 2009 at the Radisson Hotel in Corning, NY.

Laurel Health System • 22 Walnut Street • Wellsboro, PA 16901 • (570) 723-0500 • 800-808-LAUREL (5287)
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