Donation Form

The Caduceus Society at CHMC

The Caduceus Society recognizes the generosity of physicians who go above and beyond excellence in care and make an annual gift of $250 or more to the Claxton-Hepburn Medical Center Foundation. Making an annual contribution provides support for enhanced facilities, emerging technologies, and evolving patient services. By helping us build a better today, we can defend more tomorrows.

Donation Information

Amount

$250

$500

Type of Donation

One Time DonationRecurring Donation

Please direct my gift to:

My gift is a tribute:

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

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Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.

Yes! I want $0.00 to go to Claxton-Hepburn Medical Center Foundation and I will donate $0.00.No. I will donate $0.00 and Claxton-Hepburn Medical Center Foundation will cover the processing costs.

Payment Information

Payment Options

Credit Card Information

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Same As Above

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Contact Us: Claxton-Hepburn Medical Center Foundation •• 125 New York Avenue, Ogdensburg, NY 13669 •• 315.393.9175 •• [email protected]