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Brigham and Women's Hospital

Email – Double Your Impact – MGB

Double your impact!

Give now to support patient-centered care, groundbreaking research, and advanced medical training.

**Donations to events or in support of runners are not eligible for this matching gift challenge.
**Gifts made to designated funds are available to be matched. However, the matched portion of the gift cannot be directed.

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Double your impact!

Give now to support patient-centered care, groundbreaking research, and advanced medical training.

**Donations to events or in support of runners are not eligible for this matching gift challenge. **Gifts made to designated funds are available to be matched. However, the matched portion of the gift cannot be directed.

Gift information

Make a gift using your Donor-Advised Fund

Gift Amount

$25

$50

$100

$250

Other

Your Gift Amount(Required)

Recurring Gift

Make this a monthly donation

Your first monthly gift will be charged within one business day, this will set the date for all subsequent automatic charges. You can cancel at any time.

Naming Message

Please indicate your personalized message and your name as you would like it to appear. (160 characters max)

How would you like your gift to be designated?

Gift Designation

Gift Designation – Other

Would you like us to send you a calendar?

Would you like us to send you a tote bag?

Premium offer item

Would you like to receive a tote bag?

Yes, please send me a tote bag

Your information

Name(Required)

Title First Name Last Name

Donor Email(Required)

Donor Phone Number

Tribute information

Tribute gift

This gift is in honor/memory of someone

Tribute Type(Required)

Name(Required)

Tribute Gift Notification Preference

Please send notification of my gift via mail

Please send notification of my gift via email

Please note, tribute notification will be sent as soon as your gift is processed.

Email of person to notify(Required)

Name of person to notify(Required)

Title First Name Last Name

This gift is from

Address of person to notify(Required)

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Special message/instructions for this tribute gift

Payment and billing information

Payment Method

Choose your payment method

Credit Card

Apple Pay

PayPal

eCheck

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

ACH(Required)

Account Number Account Type Routing Number Account Holder Name

Corporation Name

Billing Address(Required)

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional information

Is Anonymous Gift

I am making this gift anonymously

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Is Matching Gift

My employer will match this gift

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Employer Name

disable this field since we now have Amply field

Matching Gift Employer Name(Required)

If the matching gift employer name is provided here, please expect action required email(s) from Amply Support (support@giveamply.com) to fulfill the matching gift process

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Matching Gift Donation ID

This is the donation id that will be passed to Amply for matching gift tracking

Is Interested in Planned Giving

I am interested in including or have already included Brigham in my trust/estate plans

Comments

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Internal Use Only

Total Gift Amount(Required)

Price: $0.00

Total Amount being Processed

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Hide Gift Designation

to control whether the gift designation option should be presented to visitors or not

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Fundraising Unit(Required)

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Appeal Program

A fundraising program that the appeal associated with, e.g. straight solicitation

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Appeal Code(Required)

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Referer URL

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User Agent

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utm_medium

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utm_source

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utm_campaign

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utm_content

This field is hidden when viewing the form

space holder

space holder for later use

This field is hidden when viewing the form

mkto_email_id

This field is hidden when viewing the form

CRM_Source_Code

This field is hidden when viewing the form

CRM_Finder_Number

This field is hidden when viewing the form

Page URL

the page url from which the form is submitted

Give by mail

You can send your gift with this printer-friendly-form to:

Brigham and Women’s Hospital
Development Office
263 Huntington Avenue #318
Boston, MA 02115-4506

Contact us

To make your gift over the phone using a credit card or if you have a question about giving, contact

Kiran Rai
617-424-4321
krai1@bwh.harvard.edu

Mass General Brigham Development Office
399 Revolution Drive, Suite 1330
Somerville, MA 02145
617 424 4231

Mass General Brigham is a non-profit, 501(c)3 charitable institution.

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