Our Children, Our Hospital Campaign
Nemours/Alfred I. duPont Hospital for Children
Yes, I want to support the campaign for the Hospital’s expansion with a gift of $
You may make your gift by visiting Nemours.org/GiveforKids. Matching gifts from companies are welcome.
Title:
First Name: Middle Initial:
Last Name:
Title: First Name: Middle Initial:
Last Name: Address:
Phone: Email:
Method of payment:
q Check for $ enclosed. Make checks payable to: Nemours
Please charge $
to my:
q MasterCard q Visa q American Express q Discover
Name on Card:
Billing Address:
City: State:
Card Number:
Zip:
Exp. Date:
Cardholder Signature:
Recognition Name Listing (as you would like it to appear in publications such as the Annual Report to Donors, Together magazine, etc.)
q
q
Please list my name as shown above. q
I/we wish to remain anonymous.
Please list my/our name as
(Example: Jim and Mary Jones, The Jones Family, etc.)
Nemours is a 501 (c)(3) organization. Contributions are deductible to the full extent of the law. Please retain a copy for your records.
To order your brick, please complete the payment form above and personalization options on other side,
or contact Jill Simonds at jill.simonds@Nemours.org.
(Spouse)
Orders must be received by June 30, 2014.
Check off the size of the brick(s) you wish to order and
print your inscription exactly as you would like it to appear.
4” x 8” size - $500
(Sample brick dedications)
Maximum of 23 characters (including spaces) per line on 3 lines
IN HONOR OF
DR. JOHN SHARPE
2013
8” x 8” size - $1,000
Maximum of 23 characters (including spaces) per line on 6 lines
I SUPPORT
NEMOURS/
ALFRED I. DUPONT
HOSPITAL FOR
CHILDREN
12” x 12” size - $2,500
Maximum of 23 characters (including spaces) per line on 6 lines
OUR CHILDREN,
OUR HOSPITAL:
BUILDING
A HEALTHIER
FUTURE
The official registration (#CH19215) and financial information of The Nemours Foundation may be obtained from The Pennsylvania Department of State by calling toll-free
(800-732-0999). Registration does not imply endorsement. If you wish to have your name removed from the list to receive this communication or future fundraising requests
supporting Nemours, please e-mail giving@nemours.org or write to us at: Nemours Fund for Children’s Health, Shands House, 1600 Rockland Rd., Wilmington, DE 19803.