Required Field(s)
Please tell us about your plans:
Select at least one checkbox.
I have made a provision in my will/trust to include Mercy Medical Center Merced Foundation.
I will make a provision soon to include Mercy Medical Center Merced Foundation through a bequest.
I have already made a planned gift to Mercy Medical Center Merced Foundation.
I would like to speak to a Mercy Medical Center Merced Foundation representative about gift planning opportunities.
First Name:
Enter a valid First name.
Last Name:
Enter a valid Last name.
Date of Birth (MM/DD/YYYY):
Enter a valid Date of Birth formatted as (MM/DD/YYYY).
Address:
Enter a valid Address.
City:
Enter a valid City.
State:
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Washington
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Wyoming
Zip Code:
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Email Address:
Email addresses must match and be valid email addresses.
Verify Email Address:
Email addresses must match and be valid email addresses.
Phone Number ((###) ###-####):
Phone number is required and must use the following format (###) ###-####.
Your name(s) exactly as it should appear in recognition:
(To remain anonymous, please check the box below)
Please enter your name(s) exactly as it should appear in recognition or check the I/We do not wish to be recognized checkbox.
I/We do not wish to be recognized.
I/We have named Mercy Medical Center Merced Foundation as a beneficiary of my/our:
(Select more than one option by holding the CTRL key)
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Area of Greatest Need
Other (specify in comments)
Gift Designation:
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Area of Greatest Need
Acute Rehabilitation Fund
Cancer Program Fund
Home Care and Hospice
Emergency Services
Patient Experience Fund
Date of Document (MM/DD/YYYY):
Dates must be formated as MM/DD/YYYY.
Comments: