Donation Form

Waggoner Foundation
Donation Form

The Jerry C. Waggoner Medical Foundation (JCWMF) is a non-profit foundation created in 1991 in honor of the late Jerry C. Waggoner, founding father of the Hutchinson County Hospital District. The Foundation's charitable purpose is to promote, sponsor and carry out health education and health service activities and objectives of the Hutchinson County Hospital District.

The Tree of Life represents an enduring way for donors to remember special people or events through charitable donations to the Foundation. Donations are recognized by engraved brass leaves or rocks placed around the Tree of Life.

Donor's Name First Last
Donor's Email
Phone - (###) - ### ####
Leaves get 4 lines of 22 characters for $100.00 donation. Rocks get 5 lines of 26 characters for $250.00 donation. Please select Rock or Leaf.
Please select Type
Items will be submitted exactly as shown. Please check your spelling and capitalization carefully. Line 1:
Line 2:
Line 3:
Line 4:
Line 5:

Donation Form

Waggoner Foundation Donation Form

Waggoner Foundation
Donation Form