John Muir Health
Print this page
Email this page to a friend
Change the site font size

Make a Gift

John Muir Health Foundation

Donate Online Now!

Or to make a gift by mail, click here, print this form, complete it, and mail it to
1400 Treat Boulevard, Walnut Creek, CA 94597.

* required information

Steps: (1) Enter Information (2) Review/Confirm (3) Submit (4) Receipt  

Yes! I want to support John Muir Health!

Please direct my gift to:

(Select one only)

Where the Need is Greatest

I wish to support a specific program or area:

Gift Information

To maximize your gift, John Muir Health Foundation accepts online contributions of $5.00 or more.
*Gift Amount: $1,000
$500
$250
$100
$50
$25
Other
$
I wish for my gift to remain anonymous Yes No
Gifts that are made anonymously will not appear in any public recognition.

Donor Information

*Title:
*First Name:
*Last Name:
Suffix:
Recognition Name (if different from above):
*Address 1:
Address 2
*City:
*State:
*Zip Code:
*Phone Number: () -
Email Address:
If provided, we will send a receipt to this email address.
I would like to receive information via email from John Muir Health Foundation. Yes No

Payment Information

*Credit Card Type:
*Expiration Date:
*Credit Card Number:
*Security Code:
(3-digit security code found on the back of Visa and Mastercard)
*Cardholder's Name:

Honor/Memorial Giving (Optional)

I want to make this gift in honor or memory of someone special. Yes No
In memory of:
and/or
In honor of:
I wish to notify someone of this honor/memorial gift. Yes No
Please send card to:
Name:
Address:
City:
State/Province:
Zip:
This gift is from:

Matching Funds (Optional)

Many employers have matching gift programs for employees and retirees through which your generosity to John Muir Health Foundation can be multiplied. As a non-profit organization, we are eligible for many matching-gift programs from corporations, foundations, and other organizations. Please check with your employer to see if John Muir Health is eligible for a matching gift from your company.
My employer has a matching gifts program. Yes No not sure
If yes or not sure, name of company:

Additional Information

General Comments: (250 word maximum)
How did you hear about our website?

Thank you for supporting the programs and services of John Muir Health!

Copyright © 1998-2008 John Muir Health