Miller-Dwan Foundation

Yes! I want to give! Simply complete and submit the form below.

Name:
Email:
Address:
City:
State:
Zip:
Phone:
Department:
Date:

My contribution through payroll deduction:

$1 per pay period ($26/year)
$3 per pay period ($78/year)
$5 per pay period ($130/year)

$10 per pay period ($260/year)
$20 per pay period ($520/year)
Other

Designated Fund: Reserved for use by the programs you select.

Solvay Hospice House
Burn Treatment
Cancer Treatment
Cancer Resource Center
CyberKnife
Darren Milliken Fund for Traumatic
Brain Injury
Adolescent Chemical Dependency
Endowment
Greatest Need
Laboratory
Adolescent Mental Health
Adult Mental Health

Mental Health (General Fund)
Outpatient Mental Health
MH/CD Patient Essentials Fund
Nursing Service
Radiation Oncology
Comprehensive Inpatient Rehab
Spiritual Center
Med/Surg
Surgical Services
Think First
Other

I would like to split my gift.
Please specify how you would like your gift divided:

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Miller-Dwan Foundation, 502 E. Second Street, Duluth, MN 55805