HEALTH  CARE  FOUNDATION
O F  N O R T H  M I S S I S S I P P I

I am pleased to help Health Care Foundation of North Mississippi to
provide quality health care for the people of our area.

Pledges:

Enclosed is my gift of $ __________________

I wish to pledge $ _________________, payable over _________________ years.

   Please bill me:__________annually, __________semiannually, __________quarterly.


Memorials & Honorariums:

My gift is: in memory of,   in honor of:

Please send an acknowledgement card to the address below:

Name: ________________________________________________________________________
              
Address:______________________________________________________________________
              
City:_____________________State_____________________Zip Code____________________

Your gift to one of the following programs or facilities will touch people
and help provide for their healthcare needs:

          Please use my contribution selected above for:
          ( ) Educational Programs ( ) Patient Assistance ( ) Area of greatest need

My name and address:

Name: _______________________________________________________________
              
Address:______________________________________________________________
              
City:___________________State_____________Zip Code______________________

Please print, fill out, & mail this pledge form to:

Health  Care  Foundation  of  North  Mississippi
830  South  Gloster  Street
Tupelo,  Mississippi   38801 - 9984

Gifts to the Health Care Foundation are tax deductible as allowed by law.
We appreciate your support.