Marian Clinic The Ultimate Gift

“The Ultimate Gift” – the gift of health

A holiday gift opportunity

Help make sure that no one in need of healing and hope goes without care. Contribute toward the yearly cost of medical and dental care for a patient at Marian Clinic.

For your gift of $120.00 (the average yearly payment from a Marian Clinic patient) we will deliver a holiday message in song and a long-stemmed rose to anyone you designate as your honoree. We will attach an acknowledgement of your gift to Marian Clinic for the well-being of an individual in need in our community.

For your gift of $20.00 (the average patient payment for a visit to Marian Clinic) you will receive a gift acknowledgement card to be given by you to your honoree.

To place an order for “The Ultimate Gift,” print this order form and mail with your payment to:

Marian Clinic, 1001 SW Garfield Avenue, Topeka KS 66604 Your tax-deductible gift will help individuals and families in need in

Shawnee County.

– – – – – – – – – – – – – – Clip here – – – – – – – – – – – – –

“The Ultimate Gift” Order Form

Your Information

Donor Name:
Date:
Phone #
Address:
City:
State, Zip:

I wish to give a donation of $20.00 and understand that an acknowledgement enclosure will be sent to me.

I wish to give a donation of $120.00 and understand that a delivery to my honoree will follow.

Gift Recipient

Please PRINT honoree name legibly. One honoree per $120.00 gift.

Honoree Name:
Address:
City:
State, Zip:

Delivery Options (Circle one delivery time)

November
Friday November 22, A.M.	Friday November 22, P.M.
Saturday November 23, A.M.	Saturday November 23, P.M.
Sunday November 24, A.M.	Sunday November 24, P.M.
December
Friday December 13, A.M.	Friday December 13, P.M.
Saturday December 14, A.M.	Saturday December 14, P.M.
Sunday December 15, A.M.	Sunday December 15, P.M.

Deadlines: November 4th for November deliveries and Decmber 4th for December deliveries.

Payment Options

Please make checks payable to: Marian Clinic

To place your order for the “The Ultimate Gift”, print this order form and mail with your payment information or check to:

Marian Clinic, 1001 SW Garfield Avenue, Topeka KS 66604
Attention: “The Ultimate Gift”