General Donation

Welcome to MedWish's secure online donation form.

If you prefer to make your donation by mail or over the phone, please call us at (216) 692-1685 for more information.
What kind of gift is this?*

General DonationUkraine Relief EffortsI'd like to make a gift in honor of someoneI'd like to make a gift in memory of someoneI am paying a Fee-for-Service / shipment-related feeDisaster Relief EffortsMusic for MedWish - DONATIONKK’s Free Spirit Fund (Kayla N. Schwartz)I'd like to purchase a MedWish Building Brick ($500)
For our records, please indicate which organization you are with and the shipment's destination country.
Whom is this donation in memory of?
Message to include with donation notification.
If you would like us to send a notification to someone about this gift, please provide their contact information here.

Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Please insert the name and address of the person this donation honors so that we can send them an acknowledgement.*

Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Optional: Include a message to the person this donation honors.
I would like the amount of my donation to be shared with this person.*

YesNo
Your Name*

PrefixFirst NameLast Name
Your E-mail Address*
Your Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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Thank you for your donation!
With your donation of $500, one brick will be inscribed with your name or the name of your honoree. All proceeds will support our recent building purchase.

Please insert the text that you want inscribed on the brick. There is an option of having up to 3 rows on the brick, each row has the maximum of 20 characters each. Remember each letter, numeral, punctuation, or space counts as a character.

Brick location to be determined. Tax-deductible amount $470.
Row 1
Row 2
Row 3
How did you hear about MedWish?
Address to send the "Shop For A Cause" pass*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please note that the final date to purchase a pass online is August 19, 2016.

If you would like to support MedWish by covering the cost of postage and credit card payment fees, please add $1 to your total contribution.
Donation Amount

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Welcome to MedWish's secure online donation form.