Make a donation to CAMC Foundation

Print this form, fill it in and, and mail it to:
CAMC Foundation  3412 Staunton Ave. Charleston, WV 25304

Donor information (All donor and gift information is confidential.)
Name*  
Phone*   Fax  
Street*  

City* 

  
State*   Zip*   
email  
(*required fields)
Gift information
Designation ___Cancer       ___Heart             ___Children          ___Medical education  ___Scholarships          ___Trauma      ___Research       ___Unrestricted    ___Indigent Care
 
Acknowledgement ___Honor gift   ___Memorial gift (amount of gift will be confidential)
 
On behalf of (Name)  
Payment information
Amount  
Type ___American Express   ___Discover   ___MasterCard   ___Visa
Card number  

Expiration date

  
Name on card  
Other
 

___Yes   ___No   I would like to receive information about the foundation's planned giving program
 

THANK YOU