The 1874 Society Donation Form - Mercy Health Foundation

The 1874 Society recognizes Mercy Health Services clinicians and leadership who give $1,874 or more in a fiscal year in support of the programs and initiatives that are essential to Mercy’s community of compassionate care.

To make your 1874 Society gift through payroll deduction, please contact Emily Boyce at eboyce@mdmercy.com, or 410-332-9547.

Thank you for your generosity!

Select Gift Amount:

The 1874 Society (enter a gift of $1,874 or greater)

Gift type:

One-time gift

Sustaining gift

Select a Gift Duration:

Total Gift: 0.00

Recognition: Please list your name(s) as you would like it/them to appear for recognition purposes

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree Name:

Family member/friend's Title:

Name of family member/friend to notify about my gift:

Family member/friend's Street Address:

Family member/friend's Apt/Box/Unit/Suite:

Family member/friend's City:

Family member/friend's State/Province:

Family member/friend's ZIP/Postal Code:

Family member/friend's Country:

Donor Information

Title:

First Name:

Middle Name:

Last Name:

Suffix:

Prof. Suffix:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal code:

Country:

Phone Number:

Phone Type:

Email Address:

Yes, I would like to receive communication from the Mercy Health Foundation.

Donor information is the same as my billing information

Billing Information