Support Kids - Driscoll Children's Hospital

Please print out, complete, and mail this form with your check or money order to:

Driscoll Children's Hospital
3533 S. Alameda
Corpus Christi, TX 78411
Attn: Ted A. Daniel

Thank you for your support!

Name _________________________________________________________________

Street ________________________________________________________________

City ___________________________________ State _____ Zip ________________

Telephone ______________________

E-mail _________________________________
          (must have if electing to receive Donor E-Mail)

Amount Donated ________________________________________________________

Please check here if:

_____ I prefer not to be listed publicly as a Driscoll Children's Hospital Supporter
_____ I prefer not to receive the quarterly Donor E-Mail

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