Donate Online

Gift Information

*
Denotes a required field

Thank you for supporting the AMA Foundation.  Your generosity enables the Foundation to provide critical support for public health and medical scholarship initiatives.

If you are interested in making a recurring gift, matching gift, pledge, or have any questions regarding this form, please contact Bell Lewis at (312) 464-2440.

Gift Amount: $
*
Example: 1000.00

A gift of $1000 or more to the annual fund adds you to our Annual Loyalty Circle Giving Society.

Please apply my gift to the following initiative or medical school:*
 
 

Learn more about the AMA Foundation's programs or honor funds.


Donate Online

Your Information

*
Denotes a required field
 
 
I would like to remain anonymous.
Salutation:
 
First Name:
*
Middle Initial:
 
Last Name:
*
Suffix:
 
Preferred Mailing Address
*
Home
Business
Address:
*
Address Line 2
 
City:
*
State:
*
Zip code:
*
Preferred Phone Number
 
Home
Business
Cell
Phone Number:
 

Your e-mail address will not be shared, sold, traded, exchanged or rented. See our Privacy Policy for more information.

 
 
I would like to receive the AMA Foundation's monthly e-newsletter.
 
 
Please send me information on planned giving options.

Donate Online

Dedication

*
Denotes a required field
 
 
Yes, I would like to dedicate my gift.
 
 
No, I do not wish to dedicate my gift.
My gift is:
 
In honor of
In memory of
Full name:
 
John Smith
 
 
Yes, notify the following individual of my gift via U.S. mail.
Salutation:
 
First name:
 
Last Name
 
Suffix:
 
Address:
 
City:
 
State:
 
ZIP code:
 

Donate Online

Credit Card Information

*
Denotes a required field
Name on Credit Card
*
 
 
If same as contact information check here
Address
*
Address Line 2
 
City
*
State
*
Postal Code
*
Credit Card #
*
Numbers Only - no spaces or dashes
This form is secure
Card Type
*
Expiration Date
*
Security Code (CID)
*
Help
Comments
 

Please submit only once -- processing may take a few minutes.