Pledge Information

The Foundation is a 501(c)(3) nonprofit organization registered with the Internal Revenue Service. A copy of the official registration and financial information may be obtained from the PA Department of State by calling toll-free within Pennsylvania 1-800-732-0999. Registration does not imply endorsement.

First Name:

Last Name:

Home Address:

City

State

Zip Code

Phone No.:

Email:

PAFP Affiliation:

Other Affiliation:

Donation Amount:

Donation Allocation:

Planed Giving

I am interested in including the Foundation in my estate planning, such as leaving a donation in my will or making a deferred gift.

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Foundation should call me:

Payment Options

If paying by check, please make all checks payable and deliver to:
PA Academy of Family Physicians Foundation
2704 Commerce Drive, Suite A
Harrisburg, PA 17110

I am making full payment now:

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Credit Card No.:

Credit Card Expires:
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Name on Card:

Security Code:

Billing Address:

Same as Home Address

City

State

Zip Code

Matching Gift

Many employers will match your gift. This match can double and sometimes triple your support of the Foundation. Check with your human resources office and if a match is available, please send the matching gift form to PAFP Foundation at the address noted above.

Employer Name:

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