Support University of Iowa Children's Hospital

Your contribution to Children's Miracle Network at University of Iowa Children's Hospital will help purchase patient care equipment, fund research, provide diversionary activities and support educational and advocacy programs for children's health. Your donation is greatly appreciated!

Supporters of Children's Miracle Network can designate their gift to support special events or funds at University of Iowa Children's Hospital. Please complete the form below specifying your project of interest. Your gift is tax-deductible, and you will receive an email receipt for your donation to Children's Miracle Network at University of Iowa Children's Hospital. Gifts over $250 will also receive a written receipt in the mail.

For your convenience, you may donate directly online using a credit card. Or, if you prefer, simply complete this form, print, mail or fax to:

Children's Miracle Network
University of Iowa Foundation
PO Box 4550
Iowa City, IA 52244-4550
Phone: 800-456-2772 or 319-467-3856
Fax: 319-335-2568

Items marked bold are required fields.

Contact Information
First Name:
Middle Name:
Last Name:
Joint Recognition:

Will your employer match your contribution?
Yes No
If so, please include the name of your company.
Company Name
Account Type: Individual Business Other
Enter address, city, state and postal code
as filed with your financial institution.
Postal Code:
Home Phone:
Business Phone:
Cell Phone:
Best time to call: a.m. - p.m. -


My gift is: A Memorial gift     A Tribute gift

Individual(s) to notify of gift:
Zip Code:
Home Phone:

I would like to make this gift a recurring pledge on my credit card with the following frequency:

One Time Amount $

Payment Information
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Card Number:
CVV2: Click here for CVV2 information.
Expiration Date: mm/yyyy

Please send me information about:
special events in my area
planned giving opportunities

Have you given to Children's Miracle Network in the Past?

How did you hear about us?




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Last modification date: Tue Jun 24 17:03:44 2008
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