Online Donation

Please complete the following form to make a donation online. When you click submit you will be redirected to our secure Paypal gateway and prompted to select the amount you wish to donate. (If you do not have a PayPal account, you can select the second option “Donate with Debit or Credit Card.”)

Your Name(s)*
Your Phone Number*
Your Email*
Your Mailing Address*
Street Address or PO Box City State / Province / Region ZIP / Postal Code Country
Would you like your donation to remain anonymous?
- Yes
- No
Would you like to make your donation in honor or in memory of someone?
- In honor of someone (living)
- In memory of someone (deceased)
- No
This donation is in memory of…
First Middle Last
This donation is in honor of…
First Middle Last
Name of a person you would like us to send an acknowledgement of your donation to:
Leave blank if none.
First Last
Address of this person:
Street Address City State / Province / Region ZIP / Postal Code
How you would like your name printed on the acknowledgement:
Special requests or questions:

Caring for North Hawaii's Families since 1986

Can we help? Have questions? Please call us at (808) 885-7547 or e-mail us at info@northhawaiihospice.org

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