Step 1
Donation Information
Donation Amount $
Gift Designation
Donation Amount
Other Amount
Donation Frequency
For the duration of
For the duration of
Number of Years
Please describe how often you
would like to make payments:
Donation Total:
Personal or Corporate Gift?
Corporation Name
Step 2
Donor Information
First Name*
Middle Initial
Last Name*
Spouse Name
Address 2
Zip Code*
Daytime Phone*
Home Phone
Donor Listings, please list me/us as
(e.g Mr. Joe Smith, Mr. and Mrs. Joe Smith)
Comments or Questions
Make Donation Anonymous
I would like to make this donation in honor or memory of someone else.
Step 3
Billing Information
Payment Type
Name On Card*
Card Type*
Card Number*
Security Code/CCV*
Expiration Date
Card Number
Expiration Date

Download ACH form - please print and mail with a voided check)

My Company Matches My Contribution
Please enter your company's name and mail your completed matching gift form to Bozeman Health Foundation.
Step 4
Tribute Information
Tribute Type
First Name
Middle Initial
Last Name
Address 2
Zip Code
Please tell us why you chose to honor this person/caregiver:
May we contact you about this gift in honor of your chosen person/caregiver?
Is this person your physician, nurse, other hospital employee, family member or friend?

"Tree of Memories"

For memorial gifts of $250 or more, we welcome you to inscribe a leaf for the "Tree of Memories".

Leaf Type:
Inscription (70 characters available, including spaces and punctuation)

"Footprint Order"

In recognition of your gift of $250 or more, we will display a silver medallion, imprinted with a footprint, the honoree's name and birth date. Memorial tributes will be recognized in gold. These medallions will be displayed in the Bozeman Deaconess Hospital Family Birth Center. You will also receive a beautifully etched glass replica of ypur medallion.

Footprint Color
Baby's Name
Baby's Lbs
Baby's Ozs
Baby's Birth Date
Please send the glass replica to: