Virgie Hegg Hospice Partners Membership Application

Membership Application Form

Virgie Hegg Hospice Partners, Inc

2011 Membership Form

Members are entitled to a copy of our spring and fall newsletter, the Annual Report, invitation to the Annual Meeting Dinner in June, and our appreciation for your support. All membership contributions are tax deductible.
Annual Contribution Categories

Individual -	$20.00	Memorial -	$100.00 In Memory Of__________________
Family -	$40.00	Sustaining -	$500.00 or more (Underwrites Fund Goal)
Other -	$____________

Name ______________________________________________________

Address _____________________________________________________

City, State & Zip ________________________________________________

Phone ______________

E-mail Address ________________________________

Please print, complete and mail this form with your contribution to:
VHHP Membership
P.O. Box 244
Cook, MN 55723