Foundation Donation Form
Thank you for visiting our Foundation Donation section.  
If you would like to make a donation to the DeSoto Regional Health System Foundation, please print out this form and mail it with your check to the address at the bottom of the form.   Checks should be made payable to the DeSoto Regional Health System Foundation.  Your donation may be tax deductible as we are a non-profit organization. Please consult with your tax advisor for full details on deductibility.
Again, thank you for your support.
DONATION FORM (Please print this form, complete it, and mail it to the address below)
Enclosed is my donation of $__________________________ to the DeSoto Regional Health System Foundation.
Please make my donation in memory of: _________________________________________________________
Please send recognition of my memorial/honorarium to:
(Name): __________________________________________________________________________________
(Address): ________________________________________________________________________________
(City):___________________________________________ (State):__________  (Zip):____________________
Please make your check payable to:
                                                                      DRHS Foundation
                                                                      207 Jefferson Street
                                                                      Mansfield, Louisiana 71052



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