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Make a tax deductible gift to support one of the many funds
and programs at SUNY Downstate Medical Center.

* required information
Your Donation

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: This transaction will count as the first payment toward your total gift amount.

Donor Funds
Select a fund for your contribution*

About Your Donation
Notes About Your Donation (Including Other Fund Information, Tickets, Etc.):
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
Is this a corporate credit card?: Yes
Name of Donating Organization/Company IF APPLICABLE:

Payment Information

Payment Method
:*   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:

To Make this Gift a Tribute Donation
I Would Like to Dedicate this Gift to:
Please Send a Card Acknowledging this Gift to:
This Gift is: In Memory
In Honor
Please Indicate How You Know Downstate:

Receive Information About Downstate
From time-to-time, we may send e-mail announcements about SUNY Downstate Medical Center. Check the box at left and make sure you have typed an e-mail address above to receive these announcements.
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your credit card will be processed