Ways To Give Donate Form Tabs Donate In Honor / In Memoriam Events Dining Booklet Donation Amount: Where would you like to give? General Donation Annual Appeal In Honor / In Memoriam Memorial Rock Garden Kanas Center for Hospice Care Zinberg 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 Would you like us to notify a friend or family member of your Rock Garden gift? Yes No Friend/Family Member Notification InformationFull Name Address Street Address Address Line 2 City State / Province / Region 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 (if applicable) Please tell us whom you would like the card to be from: (example, The Doe Family or John and Jane Doe)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? Sponsor A Camper Valentine Salon Taking Care of our Island Shelter Island Cocktail Party Annual Pig Roast Annual Summer Gala Golf Outing Annual Box Art Auction Tree of Lights 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: Annual Valentine Salon LuncheonHelp support Camp Good Grief 2022. 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 Cocktail Party on Saturday, June 4, 5:30-8pm at Gardiner's Bay Country Club to support East End Hospice's hospice care on Shelter Island and the East End. For more information or sponsorship opportunities, please call our Development office at 631.288.7080.Cocktail Party Ticket Price: $200.00 Quantity: Junior Supporter (under 35 yrs) Price: $100.00 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 GalaWe are currently SOLD OUT. East End Hospice's A night Under the Stars Summer Gala on Saturday June 25th at a beautiful waterfront estate in Quogue, 7 to 11pm. Gala - PlatinumVIP Reserved Table of 12 with platinum full page journal advertisement Price: $0.00 Quantity: Gala - AngelVIP Reserved Table of 10 with gold full page journal advertisement Price: $0.00 Quantity: Gala - BenefactorReserved Table of 8 with silver full page journal advertisement Price: $0.00 Quantity: Gala - PatronReserved Table of 6 with bronze full page journal advertisement Price: $0.00 Quantity: Gala - SponsorIncludes 4 tickets and listing in invite and journal Price: $0.00 Quantity: Gala - DonorIncludes 2 tickets and listing in invite and journal Price: $0.00 Quantity: Gala TicketOver the age of 35 Price: Gala Junior TicketUnder the age of 35 Price: $0.00 Quantity: Donation AmountThere are no tickets available to purchase, but if you would like to make a donation in support of EEH enter gift amount: Golf OutingOur 2022 Golf Outing will be held Thursday, September 1 at North Fork Country Club, Cutchogue, https://www.eeh.org/events/event/east-end-hospice-golf-outing/ Individual Golfer Price: $750.00 Quantity: Foursome Price: $3,000.00 Quantity: Cocktail Reception Ticket Price: $200.00 Quantity: I cannot attend but would like to donateSponsorship Amount: Annual Box Art AuctionOur Annual Box Art Auction has been been will be held in person this summer August 2022 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 Bobbie Braun. 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: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, 2022 through April 30, 2023. Thank you and please contact us in February for our next book or email us ddoyle@eeh.org Price: $100.00 Quantity: 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:CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
