SECURE ONLINE GIFT FORM (SSL Secure)

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Gift Amount

For gifts of $1,000 or more, you are recognized as a member of

The Bertha L. and Moses H. Cone Society. Thank you.

Please note the frequency of your donation.

Donation Amount*
  • $100
  • $500
  • $1,000
  • Other $

Gift Purpose

Designation*
  • Cone Health Caring Fund
  • Patient Assistance Fund
  • Support Both Funds
  • Other Designation
Other - type designation here

Honors and Memorials

This gift is:
  • In Memory of
  • In Honor of
Honoree's Name
For the following occasion:

 

Please Notify:

Name
Address
City
State
Postal Code
Country

Your Information

 

Spouse/Partner:

Title
First Name
Middle Initial
Last Name

Enter address, city, state, and postal code

as filled with your financial institution.

Country*
Email*
Confirm Email*
Daytime Phone*
List name(s) in donor recognition materials as
Check if you want this gift to be anonymous

 

For assistance with this form or information about other giving opportunities, please call 336.832.9450 during business hours (8:30 am –5 pm Eastern) or email institutional.advancement@conehealth.com.

 

Thank you.

 

Payment Information

Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
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