Print this form and mail it to us at the address below. I’m supporting the Mission Outreach Program $________ is the amount I can give to continue the Sisters’ mission.   All donations are tax deductible Please make checks payable to: HOSPITAL SISTERS MISSION OUTREACH (HSMO) Name ___________________________________________________________________ Address __________________________________________________________________ City ______________________ State _____ ZIP ____________  Phone ____________________________ (optional) Email ____________________________ (optional) Send this form and your contribution to: Hospital Sisters Mission Outreach Development P.O. Box 1665 Springfield, Il 62705-1665