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Foundation GIFT
As a special way of caring, enclosed is my gift of:

___$10___$25__$50
___$75___$100__$250
___$500___$1,000___other ______

From ___________________________________________

Address__________________________________________

City _____________________________________________

State ________________Zip ___________

In memory of ~ In honor of ~

Please inform _____________________________________

Of this gift (amount not disclosed)

Address__________________________________________
City _____________________________________________
State _________________ Zip ___________

Please return this form with your donation and mail to:

Logan Medical Center Foundation
P. O. Box 1017
Guthrie, OK 73044
405-260-4170
All gifts are tax deductible to the fullest extent of the law.
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200 S. Academy | P. O. Box 1017 | Guthrie, OK 73044 | 405.282.6700