A Star is Born

An opportunity to mark the beginning of a new life and leave a legacy for a child born at West Lincoln Memorial Hospital.

  1. Donor Information

  2. Donation Information

  3. $50.00
  4. Newborn Information

  5. Parent Information for Notification

    (Please complete this section ONLY if different from donor information.)

  6. Payment Information

  7. $0.00
  8. 3-digit value located on back
  9. Miscellaneous

  10. Confidentiality

    I understand that West Lincoln Memorial Hospital Foundation Inc. will keep my donation information I provided here confidential and agree that the Foundation may forward information or requests for donations in the future.