SGSU Contribution Form

SGSU Kimbrough
Contribution Form

Donation

We thank you for your consideration in making a contribution to support our SGSU organization and programs.

All benefactors are gratefully acknowledged on the SGSU web site and in the annual meeting program - unless you indicate otherwise.

First Name *

Middle

Last Name *

City *

State/Province/Region *

Country *

Email Address: (for confirmation) *

Acknowledgment listing okay? *

Yes

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

Donate - $50

Donate - $100

Donate - $150

Donate - $250

Donate - $500

SGSU 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@govurology.org) for assistance. Thank you.

NOTE: Organization dues may be deductible as professional or business expenses, to the extent allowable by law. Dues and other contributions are not deductible as charitable contributions for federal income tax purposes.