Please ask your hospital or social worker for a referral. They can contact Guest Services at 312-996-1167.
MENU
MENU
About Us
Mission & Vision
History
Hospital Partners, Program Sponsors & Supporters
Board of Directors
Associate Board
Associate Board Contact Form
Staff
News & Media
Financial Information
Privacy Policy
What We Do
Discover Our Stories
Your Impact
Get Involved
Ways to Give
Volunteer
Volunteer Calendar
Recipes
Login
Stay Connected
Contact
Follow Us
Newsletter Sign up
Stay with Us
Who We Serve
Our Services
Room Rates
Payment & Financial Assistance
Arriving & Departing from IMD Guest House
IMD Guest House Pictures
FAQ
DONATE
×
Close
Timeout Warning
Your session is about to time out, do you want to continue your session?
60s
left.
In Kind Donation Commitment Form
Donor name as it should appear on acknowledgement material
*
Anonymous
N
I wish to be an anonymous donor
Contact Name
*
Contact Email
*
Contact Phone Number
Company Name
Street Address
Street Address 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavat Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip
I/We are making an in kind donation of
Description:
Or
I/we are making an in kind Community Room donation of (please check all that apply):
New/Gently used DVD and Blueray Movies
New/Gently used Books
Magazine Subscription/s (Such as Sports Illustrated, Home and Garden, Fitness and Health, Marie Claire, etc.)
New/ Gently used Board Games
Household Cleaning Products (Such as dish soap, disinfecting spray/wipes, sponges etc.)
Gift Cards to Target/Jewel/Peapod/Instacart
(Optional) Estimated Total Value:
How did you hear about IMD Guest House?
IMD Guest House Board of Director Member
IMD Guest House Associate Board Member
IMD Guest House Staff Member
Website
Volunteer
Email
Mail Piece
By signing below I confirm my commitment to donate the item/s listed above to IMD Guest House
*
Date
*
Powered by NeonCRM
Scroll to top