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The Spencer Kult Memorial Family Assistance Fund (Spencer’s Fund) is a family assistance program providing meals, groceries, assistance with travel and lodging expenses, and utility payments for members of the Congenital Heart Information Network (C.H.I.N.) experiencing extended or far-from-home hospital stays.  Your donation will help Spencer's Fund provide groceries, meals, travel subsides, lodging assistance, and utility payments to members and their families in need.


Spencer Kult Memorial
Family Assistance Fund
Donation Form

In accordance with our privacy policy, this information will only be used to process your donation.  You will not be placed on any mailing lists, and we never share our list of donors with anyone.

The Congenital Heart Information Network (C.H.I.N.) is a 501(c)3 tax-exempt organization.  Donations to Spencer's Fund are tax-deductible as a charitable contribution. If you have email, you will receive an email message that you may print as your receipt, or we will mail you a receipt. 


Amount of Donation

  $  

 

 

(U.S. Dollars)

Email Address 

 
   

We will email your receipt to this address. Please type None if you do not have an email account and we will send your receipt by postal mail.


 Memorials and Tributes (Optional)

Is your gift a memorial?  If so, the donation will be made in the memory of the person you enter below.  Examples:

  • In loving memory of John Smith

Is your gift a tribute?  If so, the donation will be made in honor of the person you enter below.  Examples:

  • In honor of John Smith's 21st Birthday
  • In honor of John Smith's Graduation

Please enter the memorial or tribute dedication here
(skip if none)


 


Acknowledgement Card (Optional)

A personal "Thank You" from Spencer's Fund will let the honoree or designated family member know of your thoughtful gift (gift amounts are never revealed). Please enter  their name and and address below and we will send a card.
 

Name(s)

 

Address

 
   

City

 

State/Province

 

Zip/Postal Code

 

Country

 
    (blank indicates U.S.A.)

 


 Your Name(s)

Please let us know how we should sign the card, and also if we may acknowledge your gift on our website.  Examples:

  • Mr. John Smith
  • John and Linda Smith
  • Mr. and Mrs. Smith
  • The Smith Family
  • From a secret admirer

If you leave the signature box blank, we will list your name as the donor unless you are donating anonymously.

If you prefer to donate anonymously, please leave the signature box blank and check the "Anonymous" box below.  We will still send a card if you entered the information above.
 

How should we sign your card and acknowledge your donation on our website?

I prefer to donate anonymously
 


 
If you have any special requests or comments for us, please add those below.
 

Comments or Special Requests (optional)

 
Please press the Submit button to submit this form. You will be taken to a secure payment page where you can donate by check or credit card.
 

   

 

 

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