Prisma Health Midlands Foundation

Thank you for your donation to Prisma Health Midlands Foundation.

Donation Information

Amount:

Healing Circle:

$ 5,000.00

Compassion Circle:

$ 2,500.00

Hope Circle:

$ 1,000.00

Atrium Society:

$ 1,000.00

Champions Society:

$ 1,000.00

Lighthouse Society:

$ 1,000.00

The Cavalry

$ 500.00

Rising Champions

$ 500.00

Other

$

*

Designation:

Other

*

Additional Information

Type of gift:

One-time gift
Recurring gift

Frequency:

On:
Starting: Ending:

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

Billing Information

Title:

First name:

Last name:

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Country:

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City:

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State:

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ZIP:

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Phone:

Email:

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Payment Information

Cardholder's Name:

*

Credit Card Number:

*

Card Type:

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Card Expiration:

/

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Card Security Code:

help

*

Matching Gifts

My company will match my gift

Company:

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Tribute Information

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Type:

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Description:

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If you would like your donation to benefit a specific program or fund that is
not listed in the drop-down menu, please indicate it in the comments box.

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