Thank you for choosing to help build an ongoing legacy of quality healthcare for everyone in our community!

Please complete the following form with your contact information.

Then click the “NEXT” button at the bottom of the screen to continue on to the secure payment- processing page to complete your donation.

Your Contact Information

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone Number *

Email *

Amount of Donation *

Please enter the amount of your donation here. You will have to enter it again on the payment form. These amounts must match. We do this to secure your transaction and make sure your information is safe.

Your Donation Options

HONORARIA

If you like, you can choose to make a donation in honor or in memory of a family member, friend or neighbor. If that is the case, please select below the type of donation you would like to give. If not, please select the "Other" option or click “NEXT” at the bottom of the screen.

Type of Donation

Please make my donation in HONOR of an individual.

Please make my donation in MEMORY of an individual.

Other.

Name of the person you wish to honor:

Name of the person in whose memory you are donating:

Optional Family Notification

If you would like the family or persons notified regarding your gift, please enter the name and address where we should send the notification:

Name and Address for Notification:

RESTRICTED GIFTS

If you would like to specify where your donation to the Noyes Foundation is used, please use this space to let us know.

Restricted Gifts Selection

If you selected other, please indicate department or service here:

After submitting this page, you will be forwarded to the payment processing form to complete your donation to the Noyes Foundation. If at any time you have any questions or concerns, please contact Kellie Sylvester at (585)335-4212 for assistance.

Donation to Noyes Foundation

Your Contact Information

Your Donation Options

HONORARIA

Optional Family Notification

RESTRICTED GIFTS