Rogers Hospital Foundation

Yes! I would like to honor a Rogers staff member who made a difference for me!

The person I would like to place in the LimeLight is: Name (print first and last)*: Treatment program name and location: What makes this person special (optional):

*Your special person will receive a letter informing them that you have made a donation in their honor. The gift amount will remain confidential. They will also receive a commemorative certificate welcoming them into the LimeLight, and your kind words about what makes them special will be privately shared with them.

Gift amount:

Designation:

Other/Comments:

Donor Information:

I would like to remain anonymous.

First Name:

Last Name:

Address:

City:

State:

Country:

Zip:

Email:

Phone Number:

Credit Card

Card Number:

Expiration Date:

CVV: ()

Permission:

Yes! You have my permission to feature some or all of my comments on the website, in social media, or in other digital/print communications produced by Rogers Behavioral Health or Rogers Foundation for marketing, fundraising or awareness purposes.

Recognition Preference:

Typing your name below serves as your electronic signature and signifies your consent to use the content you provided.

Florida Department of Agriculture & Consumer Services Registration #CH41317 A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.