Lights of Love Donation Page | Ladies Board of Inova Loudoun Hospital

I wish to give a light
(When giving more than one Light, please fill out separate forms for each.)

In Honor of

In Memory of

Name (As it should appear in Book of Remembrance)

Given By (Name as it should appear in Book of Remembrance)

Donation

$25$50$100 (Star Giver)

Custom Amount

Name

Last

Address

Wording for Donor's Signature Line

Donor Name (First)

Donor Name (Last)

Address