Operation Good Samaritan Response Form

To extend a Helping Hand, please print this response form page and mail to:

Operation Good Samaritan
Department of Plastic Surgery
Loma Linda University
11175 Campus Street, CP 21126
Loma Linda, CA 92354

Name: ___________________________________________________________________

Address: _________________________________________________________________

City/State/Zip: ____________________________________________________________

I wish to make a donation to Operation Good Samaritan of $_______________________:*

_____ My check is enclosed
_____ VISA
_____ MasterCard
_____ Discover
_____ American Express

Credit card number: _______________________________________________________

Credit card expiration date: _________________________________________________

Signature (credit card gifts): __________________________________________________

Please call me at (______) _____________________ to discuss gift, tax, or estate options.

*Contributions are tax-deductible.