Support McLeod Health Foundation

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

McLeod Health Foundation
P.O. Box 100551
Florence, SC 29502

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 McLeod Health Foundation Supporter
_____ I prefer not to receive the quarterly Donor E-Mail