Give Now – Good Samaritan Foundation

Your generous gift makes amazing things happen.

Many exciting things happen through the Good Samaritan Foundation-Dayton.

Your Gift

Our Greatest Needs Campaign is our general giving category where the Foundation will select which program has the most need for your gift. If you have any questions or need help filling out this form, please contact us at (937) 208-4623 or learn more about our programs.
Please select a program for your gift:
Designate your gift amount:*
- $1000
- $500
- $250
- $100
Make This A Recurring Monthly Gift
- Make This A Recurring Monthly Gift
We will automaticaly receive your gift each month
Gift Total:
Product Name
Price: $0.00
Dedicate My Gift.
- Dedicate My Gift.
Honor someone special or memorialize someone who has passed with your gift.
Honor Gift Type
Honoree First Name:
Honoree First Name:
Honoree Last Name:
Send a special notification card by mail by filling out the information below. (Optional)
First Name (Person to Notify):
Last Name (Person to Notify):
Address:
City:
State:
Zip/Postal Code:
Message to person / familty: (Maximum of 255 Characters)
Comments:
- I wish my gift to remain anonymous

Please enter your information below. If you choose to opt in to our e-communications below, you will be kept up to date on upcoming programs, events and giving opportunities for Good Samaritan Hospital Foundation.
Fields marked in red are required for credit card submission
First name*
Last Name*
Email*
Phone
Address
Address 1 Address 2 City State ZIP Code
Employee Number
(Required only for GSH Employees. Retirees from GSH or current volunteers, please enter "2016.")
- I would like to receive e-communications from Good Samaritan Hospital Foundation.
Your credit cart details are sent via a secure SSL connection for payment processing. We do not store your credit card information so you can rest assured that your info is safe and sound.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Please note: if you encounter any issues completing your online gift, please call (937)734-4483 or email foundation@gshdayton.org

Please review the information below and edit the information or confirm that all is correct before submitting payment.
Your Gift

Total Gift Amount: {:71:currency}

Donor Level:

Program Gifted To:
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Gift Dedication: {:52} {:53}

Notification Letter:

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Your Information

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You have been added to our email list.

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Payment Method

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