Pledge FormBy Susan Lockett / November 4, 2020 A member of the Foundation Team will be in touch to collect your payment information and confirm when you would like to begin pledge payments. MG Program – Caring Physician and Midwife Campaign Pledge Form Contact InformationName* First Last Home Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Email Business Email* Home PhoneBusiness Phone* Pledge InformationPledge Amount*Number of years*Payment Frequency* Monthly Annually Date to Commence* MM slash DD slash YYYY Recognition Information*please selectI wish my gift to remain anonymousPlease include recognition as followsPlease enter name as you would like it to appear on all recognition material* I wish to learn more about leaving a gift to CMH in my will. Send me more information.
