Support Pullman Regional Hospital

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

Pullman Regional Hospital Foundation
835 SE Bishop Boulevard
Pullman, WA 99163

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:

_____ You prefer not to be listed publicly as a Pullman Regional Hospital Supporter
_____ You prefer not to receive the bimonthly Donor E-Mail