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Old Hospital Memories
Submit your memories below.
	First Name:
	Last Name:
	Phone Number: Example: xxx-xxx-xxxx
	Email Address:
	Memory:
	I hereby consent to and authorize the use of my memory Pinckneyville Community Hospital or anyone authorized by Pinckneyville Community Hospital, for any purpose, including, but not limited to news releases, marketing, advertising, videos, fundraising, the hospital website, social media sites and media interviews.