Northern Dutchess Hospital - A Century of Serving Our Community

Choose to make a difference!

To make a donation, please print this page and fill out the form below.
Donations are sent to: P.O. Box 5002, Rhinebeck, New York 12572

Giving Clubs	Friends
Stewardship Society	Gifts of $10,000 or more
Benefactor's Society	Gifts of $5,000 to $9,999
Patron's Society	Gifts of $2,500 to $4,999
Beatrice T. Cozine Club	Gifts of $1,000 to $2,499
Founder's Society	Gifts of $500 to $999
Cornerstone Club	Gifts of $250 to $499
Century Club	Gifts of $100 to $249
Foundation Friends	Gifts of $1 to $99

The Jane Braitmayer Smithers Bequest Society recognizes donors who have arranged for gifts through deferred estate plans. Please call the NDH Foundation Office if you wish to discuss planned giving options.

Choose to make a difference!

Enclosed is my/our tax-deductible gift in the amount of $_________________ in support of the Annual Fund. Please make checks payable to NDH Foundation. If you or your spouse work for a matching gift company, please enclose the company's matching gift form. If you prefer, you may charge your gift to:
Visa or Mastercard

Account #____________________________________________ Exp. Date _______________________

Signature____________________________________________________________________________

Your gift does make a difference!

Mr. Ms. Miss Mrs. Mr. & Mrs.
Dr. Dr. & Mrs. Drs. Other:___________

Name_______________________________________________________________________________

Address______________________________________________________________________________

City/State/Zip_________________________________________________________________________

Unless specified as anonymous, gifts will be acknowledged in certain Hospital publications.

Please check here if you wish this gift to be anonymous.

Thank you for your support!

PO Box 5002, 6511 Springbrook Avenue
Rhinebeck, New York 12572
845-876-3001