Light Up a Life 2009 Memorial Form

Your Name: __________________________________________ Phone: (____) ____________________

Address: ________________________________ City: ____________________ St: ____ Zip: _________

Email Address: ________________________________________________________________________

Your gift of □ $15 □ $25 □ $50 □ $100 will illuminate a Hospice Memorial Tree from December 2nd to January 2nd. To be a Star Patron a donation of □ $150. You can also call in your donation to (805) 544-2266.

□ I am enclosing a check made out to Hospice of San Luis Obispo County
□ please charge my Credit or Debit Card □ Visa or □ MasterCard

Card # _____________________________________ Exp. Date _________ 3 Digit security code ______

Billing address if different: _________________________________City: _________ St: ___ Zip: _____

Signature authorizing charge: ________________________________________

The donation is made In Memory of: _______________________ In Honor of: ____________________________

Send Acknowledgement to: _________________________________

Address: _________________________ City: ____________________ St: _____ Zip: _______

Consider becoming a Constant Heart Supporter:

□ I would like to pledge $_____ on a monthly basis beginning on the ____ day of _______, 200 __
□ Charge my credit or debit card above.
□ Transfer the pledged amount from my checking account (Please enclose or fax a voided check)

Authorizing signature: ________________________________________

Your gift is tax deductible and greatly appreciated. Please consider including Hospice of San Luis Obispo County in your Estate Planning or Will.

□ I have provided for Hospice of San Luis Obispo County in my Will or Estate Plan
□ I would like more information about the benefits of Planned Giving

Hospice of San Luis Obispo County is a non-profit 501(c)(3) organization Tax ID #95-3195126
Mail to: 1304 Pacific Street, San Luis Obispo CA 93401 * Fax to: (805) 544-6573
Phone (805) 544-2266 * email: hospiceslo@hospiceslo.org