Make a donation to Franklin Community Health Network using our secure form below.
If you wish to make a gift of securities, please contact the FCHN Foundation Office at 207-779-2750.
* = required
Name* Please print name(s) as you wish it to appear in publications.
The names of all donors of $5 or more will appear in our Annual Report next fall. Donors of $500 or more will also be listed on a plaque in the Hospital lobby.
President's Circle: $5,000 and over Founder's Circle: $2,500-$4,999 Benefactors Circle: $1,000-$2,499 500 Club: $500-$999 Donor's Club: $100-$499 Contributors: $5-$99
Unrestricted Martha B. Webber Breast Care Center Community Health Care for the Financially Disadvantaged Child and Adolescent Developmental Pediatrics Education Employee Fuel Assistance Fund Equipment Emergency Department Renovations Behavioral Health Medical Arts Building Fund in Livermore Falls Annual Appeal Employee Annual Appeal Sugarloaf HealthCare Golf Classic Sugarloaf Charity Summit Battle for Breast Cancer Field Hockey Tournament Specific Hockey Team: Big Man Battle for a Cure Specify Football Team: Champions for Children Basketball Tournament Auxiliary Maine Medical Center/Tufts University School of Medicine medical students Other
Name on the Credit Card* First: Last:
State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Credit Card Number*
Credit Card Expiration Date*
Card CVV Number* Mastercard/Visa - The last 3 numbers on the back of your card
Gift in Memory Of OR Gift in Honor Of
I wish to remain anonymous
Please send me information on planned giving and/or the FCHN bequest program
I have already remembered Franklin Community Health Network or one of its affiliates in my will
111 Franklin Health Commons, Farmington, ME 04938 - (207)-778-6031