SJMC: Donation Form

To make a donation to St. Joseph Medical Center,
please fill out the form below.

Thank you for supporting patient care!

Memorial and Special Occasion Gifts allow you to memorialize a loved one or honor a friend or relative on a special occasion. St. Joseph Medical Center Foundation will send notification that a gift has been made, as you direct. If you would like your gift to be used in this way, please fill in the appropriate blanks below.

Matching Gifts – Many companies will match gifts made by their employees to non-profit hospitals. Please contact your Personnel Department to find out whether they have a matching gifts program or list the name of your company below.

Company Name:
Address:

My name is (donor):
Phone:
Address:
City:
State:	Zip:
E-Mail:
Donation Amount:	$

PAYMENT OPTIONS

	Mastercard
	Visa

Name on Card
Card Number(no spaces)
Expiration Date(mmyy)
Security Code (What is this?) Please enter the Card Validation Number from your credit card.

My Gift is:

In Memory of:

In Honor of:

Other (please specify)

Anniversary Birthday Promotion

Send acknowledgement of my gift to:

Name:

Address:

City:

State:

Zip:

Please designate this gift to be used for:

The Heart Institute The Orthopaedic Institute The Cancer Institute	Community Outreach Pediatrics Tanzania Mission
Other: Unrestricted (To be used at the discretion of the Foundation Board of Directors)

I request more information about:
A speaker for my civic organization
Benefits from giving cash, securities and personal property
Gifts that pay an income
Donating through my estate
Please send me additional gift envelopes
Other

Your financial gifts are tax deductible as provided by law. Thank you for your generosity!

St. Joseph Medical Center Foundation, Inc. is registered as a 501(c)(3) non-profit organization. A copy of this registration may be obtained, for the cost of postage and copies, by contacting Maryland’s office of the Secretary of State. A copy of our financial statement may be obtained by writing to St. Joseph Medical Center Foundation, 7601 Osler Drive, Towson, MD 21204-7582.

Your name will be listed in St. Joseph Medical Center Foundation publications for recognition of your gifts unless we are notified otherwise in writing. If you wish to have your name removed from future mailings that include requests to support the St. Joseph Medical Center Foundation, please notify us of your preference in writing.