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Supporting Children's Specialized Hospital Foundation
Your Donation
Donation Option
*
One-Time
Monthly
per month
Donation Amount
*
Maximum Amount to Donate (Optional)
$
Total
Is this gift anonymous?
Designation:
[Select...]
Where the Need is Greatest
New Brunswick Inpatient Hospital
Long Term Care
Other
Other:
Is this an Honor or Memorial gift?
Yes
No
Is yes, select the tribute type:
[Select...]
Honor
Memorial
Are you celebrating an occasion?
[Select...]
Mother's Day
Birthday
Engagement or Wedding
Graduation
Birth
Anniversary or Special Occasion
Other
Personal Message to Tribute (300 characters):
Tribute's Full Name
Tribute's Street Address
Tribute's City
Tribute's State
Tribute's Zip Code
(ex: 12345, 12345-1234)
Corporate Giving
Individual Gift
Gift on behalf of my company
Employer Name
Company Name
Payment
Payment Method
*
{accountType} ending in {accountLastFour}
{accountType} ending in {accountLastFour}
Choose a different way to pay
Contact Details
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Name
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Receive important news and updates from Children's Specialized Hospital Foundation
Yes
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Yes! I’d like to cover processing costs. (
per month
per year
per
)
Set a time limit on monthly donations?
*
No
Yes
Donate for
*
Months
Enter a duration between 2 and 99 months.
