Mercyhealth Development Foundation

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for joining Physicians Circle at Mercyhealth.

We sincerely thank the physicians who have been donors to the Foundation in the past, and are grateful to every physician who continues or renews membership in the Physicians Circle.

Total gifts of $500 or more during a calendar year qualify physicians for membership in the Physicians Circle.

Annual gifts of $1,000 or more are eligible for recognition as a Triumvirate Society donor.

Lifetime total giving of $10,000 or more qualifies for Permanent Triumvirate Membership and inclusion of your name on the beautiful glass donor wall in the hospital lobby.

Please accept my gift of

$500

$1,000

$1,500

$2,000

$2,500

Other Gift Amount

Choose A Frequency

Recurring Frequency:

Please use my Physicians Circle Gift:

*Other gift information:

Donor/Payer Information

First Name: *

Last Name: *

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Other Suffix:

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

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Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

I would like to make a gift of appreciated securities; please contact me.

I would like to learn more about making a legacy gift and including the Mercyhealth Development Foundation in my estate plans.

I would like more information about the foundation's free, confidential Estate Planning Review Service.

Please send my gift acknowledgment to the following address rather than my billing address

Address:

Address 2:

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State:

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The Mercyhealth Development Foundation is a 501(c)(3) charity
and gifts to the foundation are tax deductible to the extent of the law.

Your Payment Information

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Expiration Date: *