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Make a Donation

We welcome your support! This form is for Upper Valley Medical Center employees only. If you are not a UVMC employee, you can give here.


Support the UVMC Foundation and improve health care in southwest Ohio


* Full Name:  
* Employee Number:  
* Department:  
* Email Address:  




* With this gift I choose to participate and    support the UVMC Foundation's:  




 


Please choose one of the options below.






One Time Credit Card Donation


* Donation Amount:

This gift is from:

* Salutation:
* First Name:
* Last Name:
* Name as it should appear in recognition:
* Address Line 1:
   Address Line 2:
* City:
* State:
* Zip/Postal Code:
* Phone Number:


Tribute gift information:

 This gift is:  

Name:
Address Line 1:
Address Line 2:
City:
State:
Zip/Postal Code:
Phone Number:

UVMC Foundation will acknowledge your tribute gift by sending an appropriate note to those you designate. The amount of your gift will not be mentioned.



Credit Card Information:

MasterCard  Visa  Discover  American Express
* Credit Card Number:
* Credit Card Expiration:  
* Security Code:
The Card Security Code is located on the back of MasterCard, Visa and Discover credit or debit cards and is typically a separate group of 3 digits to the right of the signature strip.



THANK YOU! We couldn’t improve health care in southwest Ohio without generous donors like you.


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