Samaritan Society Donation Form - St. Elizabeth Foundation

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Samaritan Society

All Samaritan donations may be fulfilled as a one time gift or through a multi-year payment schedule. If you are currently a Samaritan Society member and would like to make a payment on-line, please go to My Giving History to do so. Additional information about the Samaritan Society and other donation or payment opportunities is available by calling the St. Elizabeth Foundation at (859) 301-3920.

Samaritan Society Statement of Intent

I am pleased to accept your invitation to become a member of the Samaritan Society. As an expression of cooperation with other Samaritan members, I hereby signify my intention, without any way legally binding myself or my estate, to contribute as follows. Please select a membership level and payment schedule. You may make a payment below or under My Giving History when a payment is due.

Amount:

Samaritan Gold Eagle

$37,500.00

Samaritan Gold

$25,000.00

Samaritan Eagle

$15,000.00

Samaritan Society

$10,000.00

Please apply my gift to:

Specify other

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Additional Information:

Type of gift:

One-time gift
Schedule a payment plan

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments or special payment requests:

Please send me the Samaritan Society statuette:

What brought you to the site to give today?

Billing Information

Title:

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First name:

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Last name:

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Country:

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Address lines:

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City:

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State:

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ZIP:

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Phone:

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Email:

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Payment Information

Payment Method:

Credit CardPledge

Cardholder's Name:

*

Credit Card Number:

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Card Type:

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Card Expiration:

/

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Card Security Code:

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