Help Mississippi's Only Children's Hospital Grow

For a limited time, you can receive a bonus Children’s of Mississippi mask and/or t-shirt when you support the Campaign for Children’s of Mississippi.

Receive a Children’s of Mississippi face mask for $15.

Receive a t-shirt commemorating the Grand Opening of the Kathy and Joe Sanderson Tower with your support of $25.

Donation and Bonus Offer Form

First Name*
Last Name*
Email Address*
Phone Number*		() -
Street Address*
City*
State*		AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip*		-
Masks
Masks	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total Masks
T-shirts
Youth Large	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total T-shirts Youth Large
Small	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total T-shirts Small
Medium	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total T-shirts Medium
Large	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total T-shirts Large
XXLarge	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total T-shirts XXLarge
3XLarge	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15	Total T-shirts 3XLarge
Total T-shirts

Total Amount
*NOTE: Your order will ship in 7 to 10 business days.

Payment Information
Credit Card Info
Card Holder Name*
Card Type*	MasterCard Visa American Express Discover
Credit Card Number
Credit Card Expiration Date*	1 2 3 4 5 6 7 8 9 10 11 12 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Credit Card CVV Number* (Located on the back of the card)