Ways To Give Donate Form Tabs Donate In Honor / In Memoriam Events Dining Booklet Commemorative Journal Advertising Donation Amount: Where would you like to give? General Donation COVID-19 Response Memorial Rock Garden Kanas Center for Hospice Care Annual Appeal Good Grief Family Bereavement Center Camp Good Grief How much would you like to donate?* $5000 $1000 $500 $250 $100 $50 $25 Other Engraving Text for Stone*First Name and Last Name Make my donation a recurring gift Yes, monthly Yes, annually No (To cancel your recurring donation, please call us at 631-288-7080.)How would you like to dedicate your gift? In Memoriam In Honor Whom are you honoring?Full Name: OccasionOccasion: How much would you like to donate?* $500 $250 $100 $25 Other Would you like us to notify a friend or family member of your memorial or in honor of gift? Yes No Please tell us whom you would like the card to be from:*(Example, The Doe Family of John and Jane Doe) Recipient Information*Full Name (include title): Recipient Address* Mailing Address: Address Line 2: City: State / Province: ZIP / Postal Code: Country: AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email AddressEmail Address if applicable: Which event would you like to donate to? Valentine Salon Sponsor A Camper Shelter Island Socially Distant Stay at Home Gathering Annual Pig Roast Annual Summer Gala Annual Box Art Auction Golf Outing Tree of Lights Annual Valentine Salon LuncheonHelp support Camp Good Grief 2021. You can make your gift online below or by phone at 631.288.7080 or by mail: East End Hospice, PO Box 1048, Westhampton Beach, NY 11978. Our EIN is 11-2878502.PLATINUM HEART: Supports Art Therapy Program Price: $15,000.00 Quantity: GOLD HEART: Supports Group Therapy Program Price: $12,000.00 Quantity: SILVER HEART: Supports Music Therapy Program Price: $10,000.00 Quantity: BRONZE HEART: Supports Arts and Crafts Program Price: $7,500.00 Quantity: DIAMOND HEART: Supports Afternoon Event Price: $5,000.00 Quantity: BRAVE HEART: Supports a Sports Program Price: $3,500.00 Quantity: BIG SISTER/BIG BROTHER: Provides Camper Gear Bags Price: $2,500.00 Quantity: KIND HEART: Provides PPE and COVID cleaning supplies Price: $2,000.00 Quantity: SPONSOR A CAMPER Supports a Child attending Camp Price: $1,000.00 Quantity: FRIEND Price: $500.00 Quantity: VALENTINE Price: $300.00 Quantity: Other Gift AmountEnter gift amount: Donation includes recognition by category on an upcoming Valentine Salon digital thank you email.How would you like your name to be listed, please enterHiddenDietary Needs Vegetarian Taking Care of our Island Cocktail Party & AuctionJoin us at the Taking Care of our Island Socially Distant Stay-At-Home Event to support East End Hospice's hospice care on Shelter Island and the East End. Your gift will be fully tax-deductible. For more information or sponsorship opportunities, please call our Development office at 631.288.7080.Stay at Home Ticket Price: $150.00 Quantity: Junior Supporter (under 35 yrs) Price: $75.00 Quantity: Other AmountEnter gift amount: Annual Pig RoastSupport our Non Event Annual North Fork Pig Roast this year as a socially distant Pignic and have a hog of a good time in the comforts of your own home on Saturday, June 5, 2021. You can start your festivities at 4:00 pm and wind down at 7:00 pm. You can stop serving food stop at 6:00 pm, but we recommend having music and dancing continue until the end. Make it a fun-filled family afternoon that includes games and activities for the youngsters – a bit of something for everyone! Help support East End Hospice's care on the North Fork and East End while showing your love for our annual pig roast. Your gift is fully tax-deductible. Thank you for your consideration, and we hope to see you in person at our Pignic in 2022.Pig Roast Special Friend Price: $150.00 Quantity: Pig Roast Supporter Price: $30.00 Quantity: Youth Pig Roast Supporter Price: $10.00 Quantity: Other Gift AmountEnter gift amount: Annual Summer GalaJoin us to celebrate East End Hospice's Summer Gala from the comfort of your beautiful home on Saturday June 26th. Your gift will be fully tax-deductible and will help East End Hospice provide vital resources to patients and families during these unprecedented times. With your support we can offer hospice and bereavement care to every family who needs us including those suffering from loss or trauma related to COVID-19.Gala Sponsor - AngelYour donation this year will be listed on our website and in advertising for the non event. Price: $10,000.00 Quantity: Gala Sponsor - Benefactor Price: $5,000.00 Quantity: Gala Sponsor - Patron Price: $2,500.00 Quantity: Gala Reservations - Sponsor Price: $1,000.00 Quantity: Gala Sponsor - Donor Price: $500.00 Quantity: Gala Supporter Price: $250.00 Quantity: Other Gift AmountEnter gift amount: Annual Box Art AuctionOur Annual Box Art Auction has been been will be held in person this summer August 2021 at St. Luke's Hoie Hall in East Hampton. Join us and celebrate our East End Artists with their amazing works of art and our generous Spirit of the Community Award honoree Donald Sussis. Purchase your tickets now before its sold out.Box Art Ticket Price: $100.00 Quantity: Box Art DonorIncludes two tickets Price: $300.00 Quantity: Box Art SponsorIncludes 4 tickets Price: $500.00 Quantity: Box Art PatronIncludes 6 tickets Price: $1,000.00 Quantity: Box Art BenefactorIncludes 8 Tickets Price: $2,500.00 Quantity: Box Art AngelIncludes 10 tickets Price: $5,000.00 Quantity: Any amountEnter gift amount:Golf OutingOur 2020 Golf Outing will be held Tuesday, September 22 at Sebonack Golf Club, Southampton, NY. Designed by Jack Nicklaus and Tom Doak, Sebonack Golf Club features panoramic views of Long Island’s Great Peconic Bay and Cold Spring Pond. Sebonack has been ranked 39th on Golf Digest’s 2019-2020 list of top US golf courses. Title, Cocktail and Breakfast sponsorship opportunities offer high profile promotional opportunities, as well as, the chance to play one of the region’s most exclusive courses. For more information please visit our event page.https://www.eeh.org/events/event/east-end-hospice-golf-outing/ Individual Golfer Price: $1,250.00 Quantity: Foursome Price: $5,000.00 Quantity: Cocktail Reception Ticket Price: $500.00 Quantity: I cannot attend but would like to donateSponsorship Amount: Sponsor a CamperIt costs $1,000 for a child to attend Camp Good Grief. Help support Camp Good Grief 2021. You can make your gift online below or by phone at 631.288.7080 or by mail East End Hospice, PO Box 1048, Westhampton Beach, NY 11978. Our EIN is 11-2878502. Thank you for generous donation.Please enter your gift amount: Tree of LightsPlease enter your gift amount: Place ornaments in memory of:I plan to attend tree of lights in: Cutchogue East Hampton Shelter Island Westhampton Beach Add special message or instruction:Dining On the East EndDine at your favorite East End Restaurants. Coupons valid May 1, 2021 through April 30, 2022. Thank you and please contact us in February for our next book or email us ddoyle@eeh.org Price: $100.00 Quantity: Back Cover (Color Ad)Full page, 7½˝ x 10˝ Price: $2,500.00 Quantity: Inside Front Cover (Color Ad)Full page, 7½˝ x 10˝ Price: $2,000.00 Quantity: Inside Back Cover (Color Ad)Full page, 7½˝ x 10˝ Price: $1,750.00 Quantity: Full Page (Color Ad)Full page, 7½˝ x 10˝ Price: $1,700.00 Quantity: Full PageFull page, 7½˝ x 10˝ Price: $1,000.00 Quantity: Half Page (Horizontal Layout)Half page, 7½˝ x 4¾˝ Price: $500.00 Quantity: Quarter Page (Vertical Layout)Quarter page, 3½˝ x 4½˝ Price: $250.00 Quantity: Business Card SizeCard size, 3½˝ x 2⅛˝ Price: $100.00 Quantity: Upload Your PDF Ads Placement of ads is on a first-come, first-served basis and cannot be guaranteed. Please supply camera-ready material for reproduction or finished ad to size. Deadline for material is May 28, 2021 YOU MAY EMAIL PDF ADS TO: TMURPHY@EEH.ORG Drop files here or Select files Accepted file types: pdf, Max. file size: 15 MB, Max. files: 3. Previous Year Please repeat 2020 ad For information, please call Theresa Murphy, 631.288.7080, Fax: 631.288.4943 or email: tmurphy@eeh.org Total: $0.00 Payment Method:* Credit PayPal Check Phone Credit CardCard Details Cardholder Name You will be redirected to PayPal to complete payment.Please make your check payable to "East End Hospice" and mail it to: East End Hospice PO Box 1048 Westhampton Beach, NY 11978‑7048We are able to take your credit card payment over the phone. Please call us at 631.288.7080.Donor Information:* Title: Mr.Mrs.MissMs.Dr.Prof.Rev. First Name: Last Name: Company Name:(if donation is coming from a business) Address* Billing Address: Address Line 2: City: State / Province: ZIP / Postal Code: Country: AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone Number:*Email:* Notes:CAPTCHANameThis field is for validation purposes and should be left unchanged.
