Pajaro Valley Community Health Trust
85 Nielson Street
Watsonville, CA  95076

I want to join the Guardian Circle

Dear Friends:

I have named or intend to name the Pajaro Valley Community Health Trust as a beneficiary in my will and want to be enrolled as a member of the Guardian Circle.

Name:___________________________________________________________________________________
                                                   (please print)

Signature:________________________________________________________________________________

Address:_________________________________________________________________________________

 ________________________________________________________________________________________

City:________________________________________________  State:__________  ZIP:__________________

Telephone: (             ) ____________________________________

E-mail Address:________________________________________

Date:_________________________________________________