Donation Form             Please print this page!

I will support the Southern California Medical Museum through my tax-deductible contribution:

Name: ________________________________________________________ 

Organization: __________________________________________________

Address: _______________________________________________________

City:__________________________________________State_____________Zip Code________

e-mail: ________________________________________________________

Phone: _____________________________

   

  

             

   

                           

              

                                 

Make checks payable to Physicians’ Memorial, Gift & Benevolence Fund (PMGBF) and indicate on your check that it is for the medical museum.

Complete this form and mail it with your check to Southern California Medical Museum, 3993 Jurupa Avenue, Riverside, CA 92506. For information call (951) 787-7700.

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Corporate Sponsor Program:

(For Businesses, Hospitals, Large Groups)

$1000 Corporate Supporter ___

$2500 Corporate Patron ___

$5000 Corporate Benefactor ___

$10,000 Corporate Golden Circle ___

$100,000 Corporate Platinum Circle ___

Friends of the Museum:

$25 Individual ___

$50 Family ___

$100 Supporter ___

$250 Patron ___

$500 Benefactor ___

$1000 Golden Benefactor ___

$5000 Platinum Benefactor ___