Medical Staff Annual Campaign

Gifts to the Medical Staff Annual Campaign help ensure that physicians at Hartford Hospital are well prepared with new information systems, facilities, services and technology to provide the best possible care to the patients we serve.  Whether you provide daily care to inpatients or care for patients in an off-campus setting, financial support enhances the standing of not only the Hospital, but the Medical Staff as well.  We need your help to reach our goal for 2022!  Fill out the form below to help support the 2022 campaign!

 

Donation Information
Contributions directed to the Medical Staff Annual Fund will provide an unrestricted gift that can put to immediate use wherever it’s needed most — including enhancing programs and services that lead to better care for every single one of our patients.
Amount:	$     *
Designation:	Women's Health Program Bone & Joint Institute Ayer Neuroscience Institute Jim Bowers and Becky Swanson-Bowers Research Fund Institute of Living Henry Low Heart Center Helen & Harry Gray Cancer Center Medical Staff Annual Fund
Additional Information (Optional)
If this gift is from a group or organization, please leave that information in the comments box. You may also leave any other information you'd like us to know about the gift in the comments.
Frequency:	Weekly Monthly Quarterly Annually On:   Sunday Monday Tuesday Wednesday Thursday Friday Saturday Starting:    Ending:   Ending:
Anonymous:	I prefer to make this donation anonymously
Comments:
Donor Information
Title:	<Please select> Miss Mr. Mrs. Ms. Admiral Ambassador Archbishop Attorney Brother C.L.U. Capt. Cmdr. Col. Colonel Dr. Drs. Estate of Family of Father Friend Friends of General Governor Honorable Judge Lt. Lt. Col. Madam Major Master Misses MSGT. Prof. Rabbi Rev. Rev. Dr. Rev. Fr. Reverend Senator Sir Sir/Madam Sister The Honorable The	*
First name:		*
Last name:		*
Country:	Australia Canada Greece Japan United Kingdom United States Spain	*
Address lines:		*
City:		*
State:	<Please Select> New AA AB AE AK AL AP AR AS AZ BC CA CAN CO CT CZ DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MB MD ME MH MI MN MO MP MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE PR PW QC RI SC SD SK TN TX UT VA VI VT WA WI WV WY YT	*
ZIP:		*
Phone:
Email:		*
Payment Information
Cardholder's Name:		*
Credit Card Number:		*
Card Type:	American Express Discover MasterCard Visa	*
Card Expiration:	01 02 03 04 05 06 07 08 09 10 11 12  / 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042	*
Card Security Code:		*
Additional Security
This is a security measure to help prevent fraud.
Unable to load the reCAPTCHA image. The public key (6LcffTQeAAAAALkZg2ij08GaImDwASnOKe-gaNSh) might be invalid for this domain. reCAPTCHATM Enter the text: Type what you hear: * Get a new challenge  |  Get an audio challenge Get a visual challenge
Tribute Information (Optional)
Please provide us with the name of the individual whom the gift is in memory or honor of: Unless your gift is anonymous, we will notify the individual or next of kin of your donation (we do not disclose dollar amount). Please disregard the "mail a letter on my behalf" checkbox.
Type:	in memory of in honor of	*
Name:		*
First name:
Last name:		*
	Mail a letter on my behalf	*