PHP Hospital Administration and Medical Staff Commitment Form

Hospital Administration and Medical Staff Interest Form
YES, the health and wellbeing of our health care team is paramount!

Thank you for your interest in donating to the Foundation on behalf of your hospital or medical staff. Please fill out the form below and someone from The Foundation Staff will be in touch with you shortly.

Gifts to the Foundation are tax-deductible to the fullest extent allowed by law and will be acknowledged as such. The official registration and financial information of the Foundation of the Pennsylvania Medical Society may be obtained from the Pennsylvania Department of State by calling 800-732-0999. Registration does not imply endorsement.
Name*

First NameLast NameSuffix
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Hospital*
How would you like to be contacted:*

EmailPhone
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Hospital Administration and Medical Staff Interest Form