Wilson Medical Online Pledge Form

Wilson Medical Center Pledge Form

Step 1: My Information

Address *
Address
City
State/Province
Zip/Postal
*Donations of $500 or more are eligible to be recognized as a L. Vincent Lowe, Jr. Leadership Giver.

Step 2: My Investment

Print this receipt and remit cash payment along with receipt to your Campaign Coordinator.
*

Credit Card *We are using PayPal as our secure server for taking payments online. You will be redirected to PayPal to make your secure pledge after you've completed this entire form and hit pledge. This will take you to PayPal and you will finalize your secure cc payment there.
Credit Card *We are using PayPal as our secure server for taking payments online. You will be redirected to PayPal to make your secure pledge after you've completed this entire form and hit pledge. This will take you to PayPal and you will finalize your secure cc payment there.
Print this receipt and remit check payment along with receipt to your Campaign Coordinator.

Step 3: My Impact

Please focus my support to impact: *