Messages of aloha to healthcare workers and employees of the HHSC East Hawai`i Region

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Please complete this form to confirm your organization's participation. This will help us and the Hilo Medical Center Foundation recognize all participating organizations when distributing the items to our healthcare workers and employees.

Deadline for ALL contributions: Friday, Oct. 15, 2021

Name of Organization *

Contact person *

Email *

Phone number *

Please indicate your organization's contribution. *

Thank you and inspirational cards

Monetary donation to help purchase small gift items for these hardworking members of our community.

Other:

Required

If monetary donation was selected from the question above, please indicate how payment will be submitted

Online (via PayPal) - scan the QR code above to make an online payment. In the note section, enter "mahalo healthcare worker contribution"

A check will be mailed or dropped off to HICC (1321 Kinoole Street Hilo, HI 96720) before Oct. 15

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