Next Generation Donation Form

If you are interested in becoming a donor for the
Children’s Hospital at Memorial University Medical Center, please
contact us to discuss how we can come together and work as a team.

Neilie Dunn, The Next Generation President
communications@nextgenerationsavannah.com

Corey Fountain, Next Generation Corporate Solicitations Chair
donations@nextgenerationsavannah.com

Donation Levels 
  Level
    $50,000 - The Super Hero Society 
    $25,000 - The Smile Society 
    $10,000 - The Playdate Society 
    $5,000 - The Joy Society 
    $2,500 - The Celebration Society 
    $250 - The Friendship Society 
    $100 - The Friendship Society 
    Other 
* required information
Donation Information
Select Gift Frequency
I would like to make a one-time gift for the following amount:
:* $
I would like to make a recurring gift.
Gift Amount* # of Payments Payment Frequency Total Gift Amount
$ X = $
NOTE: Each payment, including the first payment, will be made on day 1 of the month based on the payment frequency you have indicated.
Contact Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:
Email:*
Payment Information
:*
:*
:*   Explain
Credit Card Type:*
                  
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
:*
:
:*
State:
:
:*
Country:*
Additional Information
I would like my email confirmation to serve as my tax receipt letter.:* Yes
By clicking Submit,
your credit card will be processed