Donate Online Now Donate Online Now Donate Online Giving to MCH Please enter your gift information below*This is my first gift to MCHI have donated in the pastBilling InformationName* First Last Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone(note: your phone number and/ or email address is reserved for MCH use only and will be used to contact you for recognition purposes and to resolve any questions about your gift)Please enter the amount you would like to donate* This gift is:*Please select oneIn response to a mailing that I receivedUnrestricted FundPeter L. Gosline Employee Scholarship FundReach Out and Read Literacy ProgramGolf TournamentNone of the aboveGift Type:Please select oneOne time giftPledge paymentHonorary giftMemorial giftEmployee campaignWhat is the name of your team for the Golf Tournament?Would you like this donation to be anonymous? I would like to remain anonymous for recognition purposes. This gift is in honor / memory of:Please send acknowledgement of this honorary/ memorial gift to: First Last Mailing Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total $0.00 Payment Form DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Monadnock Community Hospital is committed to protecting your privacy rights. MCH keeps all personally identifiable and credit card information private. We will not sell or provide credit card information to an external party. Optional Notes and QuestionsIf you would like to make a pledge in any amount to MCH or if you would like more information about planned giving, please contact Laura Gingras, VP of Philanthropy and Community Relations at Laura.Gingras@mchmail.org or (603) 924-4666 This iframe contains the logic required to handle Ajax powered Gravity Forms.
