Donors may submit this form to make planned and estate gifts to the Foundation...

AAP Foundation Visionary Society Commitment Form

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Donors may submit this form to make planned and estate gifts to the Foundation.

The AAP Foundation was established to serve both the needs of periodontists and also to provide for the future funding of research and education. In order to celebrate the significant generosity of those who make planned gifts to the AAP Foundation, a recognition society was created and named the Visionary Society.

Membership in the Visionary Society is open to donors who submit this commitment form indicating their intention to make an estate or planned gift of $10,000 or more to the AAP Foundation. To retain membership in the Society, the donor must provide documentation of the gift to the Foundation. Donors will be recognized within the giving levels specified below.

I plan to make a commitment to my specialty and hereby enroll as a Member in the AAP Foundation Visionary Society. The Foundation will receive official documentation of my gift on or about:

    Date

Please recognize this commitment as follows (i.e. Dr. and Mrs. John J. Smith):

    Name for publication

My Gift should be recognized at the following level (please check):

    Bronze ($10,000 - $74,999)
    Silver ($75,000 - $199,999)
    Gold ($200,000 - $999,999)
    Platinum ($1 million and more)

    I do not wish to have my name or gift publicized. Please list me as “Anonymous”

I would like for my future gift to support:

I prefer to be contacted regarding my gift at the following mailing address, telephone and/or e-mail address:

    Street address 
    City 
    State       Zip
    Phone number 
    E-mail address 

All submitted information will be held in confidence.




If you prefer to mail or fax the commitment form, please send it to:

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