Give Now Donation Information Amount: Make a gift of$ 500.00 Make a gift of$ 250.00 Make a gift of$ 100.00 Make a gift of$ 50.00 Make a gift of$ 35.00 Other $ * Designation: Dental Resource Center - Laconia Cardiac Equipment at Concord Hospital - Laconia Bridge to Recovery Walk Hope Resource Center Cardiovascular Institute Family Health Center Dental Clinic Pedaling for Hope Concord Hospital Initiatives About My Gift Frequency: Weekly Monthly Quarterly Annually On: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting: Ending: Ending: Corporate: This donation is on behalf of a company Anonymous: I prefer to make this donation anonymously Comments: Intended Location: <Please select> All Concord Franklin Laconia * Reason for Giving To Support Pedaling for Payson To Support Rock 'N Race To Support The Bridge to Recovery Walk To Support The Lakes Region Annual Gala To Support The Annual Golf Classic To Support The Challenge Scramble Golf Tournament To Support the Annual Benefit Gala To Support Crafts, Drafts & Barrels * Billing Information Title: <Please select> Attorney Cantor Dr. Elder Fr. Imam Miss Mr. Mrs. Ms. Rabbi Rev. * First name: * Last name: * Country: United States Canada * Address lines: * City: * State: <Please Select> AA AE AL AK AB AS AP AZ AR BC CA CZ CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MB MH MD MA MI MN MS MO MT NE NV NB NH NJ NM NSW NY NL NON NC ND MP NT NS NU OH OK ON OR PW PA PE PR QC RI SK SC SD TN TX UT VT VI VA WA WV WI WY YT * ZIP: * Phone: * Email: * Payment Information Cardholder's Name: * Credit Card Number: * Card Type: Visa American Express Discover MasterCard * Card Expiration: 01 02 03 04 05 06 07 08 09 10 11 12 / 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 * Card Security Code: * Matching Gifts Many companies will match employee gifts. Please check with your Human Resources Department and submit proper documentation via email to CHTrust@crhc.org. My company will match my gift Company: * Tribute Information Please tell us if someone is being honored or remembered with this gift. Tribute Type: in honor of in memory of Grateful Heart Award * Name: * First name: Last name: * Send notification of this gift to the following person: *