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$2,500Enter AmountEnter 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 ofIn Memory ofHonoree'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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code DesignationDesignation:*General DonationClay ShootDazzle Me PinkFriends of Fit-N-WiseGrateful PatientMary'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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 EmailThis field is for validation purposes and should be left unchanged.
