Member Portal | Florida Hospice & Palliative Care Association

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*Method of Payment for FHPCA Donation Form

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Other (Please contact the FHPCA office for information about gifts of security and other options )

Donor Information

*First Name:
*Last Name:
*Billing Address:
*City:
*State:
*Zip Code:
*Telephone (home):	(XXX-XXX-XXXX)
*E-mail:

My Gift In Memory Of:

*(Name)

Mr.

Mrs.

Ms.

Please Notify The Following Individual(s) Of This Memorial Gift (without mention of Gift Amount):

Name:
Relationship to Honoree:
Address:
City:
State:
Zip Code:
Telephone (home):	(XXX-XXX-XXXX)

Gift Information

*My gift in amount of:

Florida Hospice & Palliative Care Association (FHPCA) is a not-for-profit, IRS Sanctioned 501(c)(3) organization representing Florida's hospice programs. Donations are tax-deductible under the law. Please consult your tax preparer for more information.

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