Foundation > Ways of Giving > Mail In

Mail in

Please print this form, complete it and mail it with your contribution. For memorials, honorariums and special occasions, complete the entire form.

I want to help our community.

____	Enclosed is my gift of $________(payable to Park Nicollet Foundation)
____	Please charge my gift: ____Visa ____MasterCard
	Account No.____________ Expires________ Signature____________

Please use my gift to support the following.

____	Areas of greatest need. Partner with Park Nicollet Foundation to support community initiatives of Methodist Hospital, Park Nicollet Clinic and Park Nicollet Institute.
____	Direct my gift within Park Nicollet Foundation to support my indicated area(s) of interest.
	$______Eating Disorders Institute	$______Park Nicollet Institute´s research and education
	$______Healthy Community initiatives	$______Park Nicollet Heart and Vascular Center
	$______International Diabetes Center at Park Nicollet	$______Other   _______________________
	$______Methodist Hospital hospice	$______Stroke INSPIRE
	$______Park Nicollet Cancer Center	$______Struthers Parkinson´s Center

Donor information

Name_____________________________________(as it will appear for recognition)

Address____________________City, State, ZIP____________________

Telephone ____________________

Memorials and honorariums

____In memory of	Please notify the following person(s) of this gift
____ In honor of	Name____________________ Address____________________ City, State, ZIP____________________ Your relationship to person____________________

A letter acknowledging your gift (without indicating amount) will be sent to the person(s) that you wish notified. Mail donations to:

Park Nicollet Foundation
6500 Excelsior Blvd.
St. Louis Park, MN 55426

For assistance, call 952-993-5023.