Tree of Life Donation Form

The Tree of Life is located in the front lobby of Gundersen Moundview Hospital and Clinics. Donors may purchase an engraved leaf, acorn or stone as a visual representation of a memorial, tribute or gift to Moundview Memorial Healthcare Foundation.

Recognition levels are:

Leaf - $100-499
Acorn - $500-1,999
Contributor Stone - $2,000-4,999
Benefactor Stone - $5,000-14,999
Supporter Stone - $15,000-29,999
Patron Stone - $30,000-49,999
Sponsor Stone - $50,000+

Please complete the information below:

Please return this form with your tax deductible donation to:
Moundview Memorial Healthcare Foundation
PO Box 40, 402 West Lake Street
Friendship, WI 53934