Affinity Health System - Donate to Calumet Medical Center

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Donate to Calumet Medical Center

Convenient giving option for caring donors

To make a gift to Calumet Medical Center, please complete the information below (fields with a red asterisk are required). We do not share your e-mail address or other information with third parties for solicitation purposes.

When you give to Calumet Medical Center, don't forget to check to see if your employer offers a matching gift program. All donations go towards programs that assist caregivers in saving and improving the quality of lives within Calumet Medical Center and its clinics.

If your program includes a printed form, please complete the form and send it to the address below.
St. Elizabeth Hospital Foundation
1506 S. Oneida St.
Appleton, WI 54915

Title

First Name*

Middle Initial

Last Name*

Street Address*

Apt. or Suite Number

City*

State*

Zip Code*

Telephone (with area code)*

E-mail Address

Pledge your support

Single payment of $

Or monthly payment of $

Start Date (for monthly giving)

(mm/dd/yyyy)

End Date (for monthly giving)

(mm/dd/yyyy)

Gift Designation* (If you are donating to Calumet Medical Center, please select "Calumet Medical Center Fund.")

If "Other," please specify

Tribute:*

In Honor Of
In Memory Of
None

Person's First Name

Person's Last Name

Occasion

Please notify the family of this gift. (Provide recipient's address below)

Yes, please notify. I prefer to make this gift anonymously.
Yes, please notify. You may mention my name in the notification.
No, please do not notify the family of this gift.

Send tribute gift notification to: (Person's Name)

Street Address

City

State

Zip Code

How did you hear about our site?*

Mailing
Radio
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Friend
Web
Television
Other

If "Other," please specify.

Type of Credit Card*

Credit Card Number*

Expiration Month*

Expiration Year*

CVV2 (three-digit code on the back of your credit card)*

To Help Prevent Spam - What is the answer to 1+1*

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Donate to Calumet Medical Center

Convenient giving option for caring donors

Pledge your support

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