UNC School of Medicine

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The Medical Foundation of North Carolina, Inc.

If you have questions please call 966-1201 or 800-962-2543.

Make a contribution to the Medical Foundation of North Carolina, Inc. in support of UNC Hospitals and UNC School of Medicine.

Please complete and print this form and mail it with your check to:
The Medical Foundation of NC
880 Martin Luther King Jr. Blvd.
Chapel Hill, NC 27514

Items marked with an asterisk (*) are required.

Last name*

First name*

Address 1*

Address 2

City*

State*

Zip*

Day phone

(please include area code)

Home phone

The best way to reach me is by: Email US Mail Telephone

If you are a student or alumnae/alumnus, enter class year:

Please designate my gift to:

$ Allied Health Sciences
$ Bowles Center for Alcohol Studies
$ Carolina Cardiovascular Biology Center
$ Carolina Vaccine Institute
$ Center for Maternal and Child Health
$ Center for Women's Health Research
$ Childhood Trust
$ Cystic Fibrosis/Pulmonary Research & Treatment Center
$ Department of Anesthesiology
$ Department of Biochemistry and Biophysics
$ Department of Family Medicine
$ Department of Neurology
$ Department of Social Medicine
$ Department of Ophthalmology
$ Department of Orthopaedics
$ Department of Otolaryngology/Head and Neck Surgery
$ Department of Pathology and Laboratory Medicine
$ Department of Physical Medicine
$ Department of Psychiatry

$	•	Ham Society Fund
$	•	UNC Eating Disorders Program

$ Department of Radiology
$ Department of Surgery
$ Diabetes Care Center
$ Division of Cardiology
$ Excellence Fund (Non-Alumni Giving)
$ Family Support Network of North Carolina
$ Gene Therapy Center
$ Lineberger Comprehensive Cancer Center
$ Loyalty Fund (Alumni Giving)
$ North Carolina Children’s Heart Center
$ North Carolina Children’s Hospital
$ North Carolina Jaycee Burn Center
$ North Carolina Women’s Hospital
$ Neuroscience Center
$ Program on Digestive Health
$ Program on Integrative Medicine
$ Speech and Hearing Advancement Fund
$ Student Health Action Coalition (SHAC)
$ Thurston Arthritis Research Center
$ UNC Hospice
$ UNC Kidney Center
$ UNC Center for Functional GI and Motility Disorders
$ Smoke Free Families
$ Other If other, for what purpose?

$ Total Contribution

Amount of check enclosed $

This gift is in

honor of
memory of

If you wish this person to be notified of your gift (amount
of gift will not be indicated), please supply their address:

Is this your first gift to the Medical Foundation? yes no

How would you like your name listed in publications?

I wish this gift to be credited anonymously.

I wish this gift to be credited jointly with my spouse.

Spouses Name

Please contact me about

Making a planned gift
Including the Medical Foundation in my will
Making a gift of securities
Making a gift of real estate
Setting up a charitable remainder trust

Comments

Please print this page and mail it with payment to:
The Medical Foundation of NC
880 Martin Luther King Jr. Blvd.
Chapel Hill, NC 27514

Privacy Statement: Information provided on this online form will be used by the Medical Foundation of NC solely for the purpose of crediting you correctly for your gift. Personal information contained in the Foundation’s records is used only for University-related business and will not be shared with outside parties.