Make a Donation

Lake Regional Fund Development invites you to make a tax-deductible gift online in support of Lake Regional Hospital.

You may choose to donate to the Endowment Fund, or you may designate where you want your funds applied, i.e., to a specific department or program of the hospital. You also may choose to donate in honor or memory of a friend or loved one.

Once you have completed the form below, you will be redirected to our PayPal site to submit your secure donation. Note: You do not need a PayPal account to make a donation.

If you have questions about any of our projects or programs or would like additional information, please contact Terri Hall, Fund Development director, at 573-348-8153 or e-mail Terri.

Gift Information

Donor Information
	* REQUIRED
Amount of donation	* Please format with decimal points (i.e., 100.00)
Title
First Name	*
Middle Initial
Last Name	*
Job Title
Company Name
Mailing Address	*
City	*
State	*
ZIP	*
Phone	*
Alternate Phone
E-mail

Donation Details
Please apply my gift to:
	Endowment Fund
	Other:
This gift is being made:
	in honor of:
	in memory of:
Donor Recognition
I prefer to make my donation anonymously.
I would like the family or individual to be notified of my gift at the following address.

Name
Address
City
State
ZIP



Lake Regional Health System does not sell, trade, rent or share personal information about our users to or with any third parties.