Memorial Giving

An opportunity to honour a special life and your gesture of sympathy will be acknowledged to the next of kin.

  1. Donor Information

  2. Donation Information

  3. Next of Kin Information

  4. Payment Information

  5. $0.00
  6. 3-digit value located on back
  7. Miscellaneous

  8. 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.