DEDICATED TO THE HEALTH OF ALL CHILDREN

Winner of Outstanding Chapter Award 1965, 1996, 2000, 2004 & 2009   

Foundation Donation Form

Pediatric Foundation of Georgia

Promote the health, safety and well-being of children in Georgia.
Promote the practice of pediatrics as a medical specialty.
Acknowledge outstanding contributions of individuals on behalf of children.
Encourage students and residents in the study and training for pediatrics via scholarship support and recognition.
Promote excellence in pediatric care through medical education programs, research, and other activities.

Contributions to the Pediatric Foundation of Georgia are tax deductible.

For more information on the Pediatric Foundation click here:  

Pediatric Foundation of Georgia

I/We would like to make a tax deductible donation to the Pediatric Foundation of Georgia in the amount of:

$25    $ 50     $100    $250 Other Amount

Name: 

Practice/Business name:

Address: 

City:                State:      Zip: 

Phone:     Email*    

*Your email address is necessary for confirmation/receipt. 

Checks should be made out to the Pediatric Foundation of Georgia . 

Please mail your contribution with this printed form to:

Georgia Chapter

American Academy of Pediatrics

1330 W. Peachtree St. NW, Suite 500

Atlanta, GA  30309-2904

Or to make a donation by credit card, complete form above and then click tab below: