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HOSPICE ON-LINE DONATION FORM

North Ottawa Community's local Hospice since 1981

Yes, I/We would like to honor or celebrate the memory of someone special by donating to the Hospice of North Ottawa Community.

My On-line contribution to Hospice of North Ottawa Community in the amount of:

$150  $50  $25  $10   Other  

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Please designate this gift
in memory of    in honor of      Name

Please send notification of this gift to: (optional)

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