|
Fort Gratiot
Hospital Museum
Help Us Tell the Story of
Medicine in St. Clair County
The first hospital in St. Clair County was built at Fort Gratiot on the current Thomas Edison Inn site.
This original hospital building was recently moved by the City of Port Huron to Lighthouse Park to become an important part of the Fort Gratiot Lighthouse museum complex.
Please help us in our efforts to preserve Port Huron's oldest
wooden structure by using the form below to make a donation, or call
(810) 982-0891 for further information.
DONOR INFORMATION (Please print or type)
Name: ____________________________________________
Billing address:______________________________________
City: ________________ State: ___ Zipcode: ____________
Phone (home): ______________________________________
Phone (business): ____________________________________
Fax number: _______________________________________
Email address: ______________________________________
PLEDGE INFORMATION
I (we) pledge a total amount of $ ________________________
To be paid: o now o monthly o quarterly o yearly
In the form of: o cash o check o credit card o other
Credit card type: o Visa o MC o Discovery o AmEx
Credit card number: _________________________________
Exp date: _____ Authorized Signature: ___________________
Make all checks, corporate pledges and other gifts payable to:
Port Huron Museum - Fort Gratiot Hospital.
ACKNOWLEDGEMENT INFORMATION
o Please use the following name(s) in all acknowledgements:
_________________________________________________
o I (we) wish to have our gift remain anonymous
Signature(s) _______________________________________
_________________________________________________
Date: _____________________
PLEDGE FORM
Fort Gratiot Hospital Museum
Phase I Reconstruction Project
Please complete this form and return to Port Huron Museum - Fort Gratiot Hospital, 1115 Sixth Street, Port Huron, MI 48060
|
