Name

Address

City, State Zip

Phone Number

E-mail Address

Challenge Drive Giving Levels

Bronze $5
Silver $15
Gold $25
Platinum $50
Lifetime Membership $150
Donation $

Please make checks payable and send to: Grinnell Regional Medical Center Auxiliary • 210 Fourth Avenue • Grinnell, IA 50112.

Please indicate new areas of involvement that you are interested in:

Blood Drive
Breakfast Service
Clerical/Mailings
Clinic Courier
Computer Data Entry
Education
Filing
Fund-raising Events
Glass Gift Box (Gift Shop)
Historian
Hospital Tours
Information Desk
In-house Mail Delivery
Legislative Issues
Living Portraits
Magazine Delivery
Membership
Newspaper Clippings
Patient Services (mail and flower delivery)
Patient Tray Favors
Pediatric Orientation (April & October)
Pet Therapy
Phoning
Receptionist
Scholarships
Senior Health Information Program
Sewing (bibs, stuffed animals)
Surgery Waiting
Women's Health Focus
Woodworking
Other