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

Choose files

You can upload up to 20 files. Each file should be less than 20 MB.

*Privacy Policy

I confirm I have read and accept the terms of the Privacy Policy

*Amount ($USD)

Please enter the amount you feel comfortable making to the Scholarship Fund. Your donation is most appreciated. Thank you

Scholarship Donation

$2.00 Scholarship Donation

$5.00 Scholarship Donation

$10.00 Scholarship Donation

$20.00 Scholarship Donation

$25.00 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

One-time

Annually

Comment

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

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