Mad River Valley Health Center
Capital Campaign
Pledge Form
Capital Campaign
PO Box 1990
Waitsfield, VT 05673
802.496.8911
capitalcampaign@MRVHC.com
Here is our pledge of support in the amount of $_____________to the MRVHC Capital Campaign.
I/we wish to fulfill this pledge over:
5 years
4 years
3 years
2 years or
Full payment enclosed.
Please contact us concerning
:
Naming Opportunities of Facilities
Gifts of Stocks (Securities)
Gifts of Property
Deferred Gifts
I would like to make my gift:
In memory of: ___________________________________
In honor of: _____________________________________
Optional:
I would like to remain anonymous in all donor lists
Please send me information about how to include MRVHC in my will and estate planning
Name of Donor:______________________________________
Address: ___________________________________________
Signature of Donor:___________________________________
Please make all checks or securities payable to:
MRVHC Capital Campaign Fund
Gifts may be pledged over 5 years and are tax deductible
Capital Campaign
Sponsorship Opportunities
