WSAUA RSF Contribution Form

Western Section AUA /
Western Urological Foundation
Resident's Scholarship Fund
Contribution Form

Thank you for making a tax-deductible contribution to support our Western Section Residents.

Through our foundation, 100% of the funds received go directly to support travel scholarships and educational programs, empowering our Residents to participate in meetings and become active leaders in the future of urology.

All contributors are gratefully acknowledged on the WsAUA web site and in the annual Program Book - unless you indicate otherwise.

First Name *

Middle

Last Name *

City *

State/Province/Region *

Country *

Email Address: (for confirmation) *

Senior Member? *

Yes

Other Other

Acknowledgment listing okay? *

Yes

The most frequently given amounts are shown below but you can choose any amount you wish in the next box.

RSF Contribution - $250	RSF Contribution - $50
RSF Contribution - $75	RSF Contribution - $100

RSF Contribution (custom)

Optional: In dedication to or in memorial of
(please state which and give full name):

General Comments:

For Office Use Only

Click "Continue" button below to review your order and payment options.

NEED HELP: Please call or email us at 714-550-9155 (info@wsaua.org) for assistance. Thank you.

Note: All Funds go to the Western Urological Foundation (WUF). WUF is a private foundation administered by the Western Section AUA with tax exempt status under section 501 (c)(3) of the Internal Revenue Code (IRC) and as further defined under IRC 509(a). For your records, our Tax identification Number is 94-2957386.