Children's Heart Fund

Please fill this form out, then Print
Please mail this completed form.

 I would like to donate to the
 International Children's Heart  Fund.

 Company/Practice Name  (if applicable)



 Address 2
 State      Zip

 Daytime Phone Number

 E-Mail Return Address


   Our Address:

    International Children's Heart Fund
   17 Shamrock Street
   Worcester, MA  01605

I am sending a gift of

     $10.00 $20.00
     $50.00 $100.00

    Enclosed is my Employer's matching
       contribution form.

International Children's Heart Fund is a full non-profit 501(c) 3 status organization Tax ID# 43-1260030.
Your 100  % Tax-deductible donations are greatly appreciated, and enables ICHF to  continue  its mission  through its programs, activities and education. All donations will  go directly to ICHF.

  How did you hear about ICHF?
  Friend  Radio/TV   Web / Search     Other
  Please Specify Web or Other 

Other ways you can help ICHF.

      Please contact me to discuss what I can do to contribute.
      I would like to volunteer in the fund-raising
      I would like to be considered for a volunteer position on a medical mission team trip.

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