Hardison Fund Donation Form - North Carolina Medical Society

Physician Wellness

The Mitchell D. Hardison, MD Fund with the NCMS Foundation allows the NCMS to devote resources to physician wellness activities. Thank you for your support!

For more information on the Hardison Fund or on the NCMS Foundation, please contact Pam Highsmith, phighsmith@ncmedsoc.org, (919) 833-3836.

Donation Information

Amount:

$ 500.00

$ 250.00

$ 100.00

$ 50.00

Other

Gift Details

WANT TO MAKE THIS GIFT IN HONOR/MEMORY OF SOMEONE SPECIAL? If you wish to have this gift serve as a tribute, please provide the following in the TRIBUTE DETAILS box below: The honoree’s name, mailing address, and whether the gift is done in their honor or in memory.

Anonymous:

I prefer to make this donation anonymously

Tribute Details:

Billing Information

Title:

First name:

Last name:

Country:

Address lines:

City:

State:

ZIP:

Phone:

Email:

Payment Information

PLEASE NOTE: It may take several seconds for your transaction to process; do not click on the donate button more than once. Although it may seem as though your submission has lagged, you should see a confirmation screen momentarily.

Cardholder's Name:

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Additional Security

This is a security measure to help prevent fraud.

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