sCHOLARSHIP fund dONATION 

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Donation

* Mandatory fields
*First name
Middle Name
If you would like to add your Middle Name, you may do so. However, this is not a mandatory field.
*Last name
Credentials
If you would like your credentials on your membership card, please type them here.
*Organization
List the hospital, institution, and/or organization that you belong to. If you are a Student Member, please list the Educational Institution that you belong to.
*E-mail
Please list the e-mail that you use most frequently. This will be the e-mail where important NYSSRS information will be sent.
*Phone
*Street Address
*City
*State
*ZIP Code
Program Director
Educational Institution
Program Phone #
Continuing Education
You can upload up to 20 files. Each file should be less than 20 MB.
*Amount ($USD)
Please enter the amount you feel comfortable making to the Scholarship Fund. Your donation is most appreciated. Thank you
Scholarship Donation
these are suggested donation amounts that our members most frequently donate. Please enter the amount you feel comfortable making in the amounts box above. Your donation is most appreciated. Thank you
 Payment frequency
Comment
 

NYSSRS, Inc. is a 501(c)6 non-profit organization. PO Box 302/ Centereach, New York 11720-0302

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