AOA Pledge Form

AOA Pledge Form
Name as you want to be recognized *
Included spouse/partner if joint gift
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Pledge Payment Options*

$500/year for 5 years ($2,500 total)$1,000/year for 5 years ($5,000 total)$2,000/year for 5 years ($10,000 total)$3,000/year for 5 years ($15,000 total)$4,000/year for 5 years ($20,000 total)$5,000/year for 5 years ($25,000 total)$10,000/ year for 5 years ($50,000 total)$5,000/year for 10 years ($50,000 total) if age 50 or younger onlyOther Amount -minimum Pledge amount is $2,500
I will pay over the course of

1 year2 years3 years4 years5 yearsOther - donation is over $50,000
Please direct my gift to the following AOA signature program(s). If you do not have a program preference, please select Unrestricted Support/Mission Critical Education of the AOA.*

Unrestricted Support/Mission Critical EducationCouncil of Orthopaedic Residency Directors Program (CORD) and Academic ActivitiesLeadership DevelopmentEmerging Leaders ProgramResident Leadership ActivitiesOwn the Bone ProgramAOA Traveling FellowshipsAmerican‐British‐Canadian Traveling FellowshipNorth American Traveling FellowshipJapanese-Orthopaedic Association Traveling FellowshipAustrian-Swiss-German Traveling FellowshipCarousel/Presidential Activities
If you selected more than one fund above, please indicate how you want your funds allocated
e.g. $5,000 to Own the Bone and $5,000 to Emerging Leaders
In addition to selecting a program(s) above, if your gift is made in tribute, please complete the following:

In Memory OfIn Honor Of“Honor an Orthopaedic Pillar”, in Honor of
Select a Pillar Tribute
Tribute Name
Are you over the age of 50 and making a donation/pledge over $50,000?

YesNo
I will pay this donation over the course of

1 year2 years3 years4 years5 years
Are you age 50 or younger and making a donation/pledge of $50,000 or more?

YesNo
I will pay this donation over the course of

1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years
Payment Method*

Check (payable to the AOA)Please send me a Pledge ReminderSecurities/Stocks
Note: If you want to make a donation using your credit card, please click this link. If you want to make a pledge payment via credit card, please click this link.
The American Orthopaedic Association (AOA) is a not‐for‐profit 501(c)(3) organization, operated and existing under the laws of the state of Illinois. The AOA does not provide legal or financial advice to donors; please consult with your own financial attorney/advisor to determine a donation structure appropriate for your personal circumstances and whether your donation qualifies for a tax deduction under federal law.

Signature
Signature Required to Complete Your Pledge*

Clear
I sign this pledge with the intent to be legally bound. If I should die prior to the time this pledge is paid, I direct that my personal representative satisfy this pledge as a debt of my estate.
Date*

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Date
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