Huron Regional Medical Center

172 Fourth Street SE Huron, SD 57350
info@huronregional.org

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Donation FAQ

Personal Information

First Name

Last Name

Address:

City:

State / Zip:

Day Phone Number

- -

Evening Phone Number

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E-mail Address

the e-mail address you specify will only be used for this purpose

Donation Information

Use of Gift

Where Needed
For:

If gift is given as a
memorial or honorarium

In Memory Of:
In Honor Of:

Payment Information

Your gift is tax deductible as provided by law.

Amount:

Payment Frequency:

Payment Method

Credit Card
Checking/Savings Account

Notification

Please notify the following individual of my gift.
(The amount of your gift will remain confidential.)

Name:

Address:

City:

State / Zip:

Your relationship
to person:

Other Information

Please send me more information about:
Including HRMC Foundation in my will
Planned giving
Volunteering

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