Make a Recurring Donation Thank you for your financial contribution to the Wise Health Foundation. Please complete the form below to submit a recurring monthly donation. Monthly Donation AmountDonation Amount* $25 $50 $100 $150 $200 $500 $1,000 $2,500 Enter Amount Enter Donation Amount: Total Donation Amount $0.00 Honor/Memorial InformationTribute Yes, this is a tribute donation in honor or in memory of someone special. Tribute Type: In Honor of In Memory of Honoree's Name First Last Mail a letter to notify someone of this donation. Notification Name: First Last Notification Address: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code DesignationDesignation:*General DonationClay ShootDazzle Me PinkFit-N-WiseGolf ScrambleMary's GiftPaint the Town PinkYear-End GivingOtherOther Designation: Grateful Patient InformationCaregiver's Location or Department: My Grateful Patient Story:Your Billing InformationName:* First Last Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number:*Email Address:* Enter Email Confirm Email Your Payment InformationPlease contact the Wise Health Foundation to make any changes to your reoccurring gift. Your continued support is greatly appreciated. Credit Card*Card Details Cardholder Name CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
