Foundation Donation

Is this donation in honor of or in memory of someone?

Would you like a notification letter sent?

If yes, where would you like the notification letter sent?

Send check, credit card information, or money order along with this form to:

Amery Hospital & Clinic Foundation
265 Griffin Street East
Amery, WI 54001

Or you can contact Joanne Jackson directly at 715-268-0303 or email her for any questions at