AFMR - Donations

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Recognize the annual AFMR Outstanding Investigator
Funds a Junior Physician Investigator
Minimum Donation for Honored Mentor Program
Contributes to a Henry Christian award
Supports a Regional Scholar
Other one time amount

For additional information on gift giving, please contact AFMR.

Your generous contribution has enabled you to add the name of an Honored Mentor as part of your donation.
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Honored Mentor Information

First Name

Last Name

Phone

Email:

Include mentor on a dedicated Honored Mentor page
Send an acknowledgement to the Honored Mentor to the email address I entered above
If you would like to include a tribute blurb, please enter it below (max: 150 words). Note: the blurb may be edited.

Your generous contribution has enabled you to send an acknowledment to your mentor as part of your donation.
Would you like to take advantage of this feature? Yes No

Mentor Information

First Name

Last Name

Email:

Donor Billing Information

Name on Card:
Address:
City:
State:
Zip:
Country:
Phone:
Email:

Credit Card Information

Donation Amount:

Credit Card Type:

Credit Card Number:

Expiration Date:

Card Security Code:

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