SAGES Education and Research Foundation

A world where all surgeries are done with the least possible physical trauma, discomfort, and loss of productivity

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Pledge Form

SAGES Foundation Giving Levels:

You may also download this form as a PDF file for contributions by check. All donations are welcome.

Donation Information
What kind of donation would you like to make?*
- One-time gift
- Annual pledge (5 years)
- Monthly (12 months)
- Apply to Pre-existing Pledge
One Time Gift Amount*
- Diamond Patron: $10,000
- Benefactor: $5,000
- Donor: $3,000
- Friend: $1,000
- Supporter: $500
- Other
Other Gift Amount*
How would you like to direct your donation?*
- General Fund
- Barbara Berci Memorial Fund
Do you want to receive a copy of Dr. George Berci’s autobiography?*
Receive a copy of Dr. George Berci’s autobiography – The Scope of My Life With your minimum $25 donation to the Foundation.
- Yes, please mail me a physical copy-US addresses only
- Yes, please send me the ebook version.
- No, thank you.
How many books would you like?*
You are entitled to 1 book per $25 donation.
Would you like a signed copy?*
- Yes
- No
What is the recipients' name - You may enter more than one name for multiple copies:*
To what address should the book(s) be mailed?*
Street Address Address Line 2 City State ZIP Code
5 Year Pledge*
Your first payment will be charged immediately and subsequent payments charged yearly for the next four years.
- Diamond Patron ($10,000 total/$2,000 per year)
- Benefactor ($5,000 total/$1,000 per year)
- Donor ($3,000 total/$600 per year)
- Friend ($1,000 total/$200 per year)
- Supporter ($500 total/$100 per year)
Apply to existing Pledge*
- Diamond Patron ($10,000 total/$2,000 per year)
- Benefactor ($5,000 total/$1,000 per year)
- Donor ($3,000 total/$600 per year)
- Friend ($1,000 total/$200 per year)
- Supporter ($500 total/$100 per year)
- Other
Other Pledge Payment*
Monthly Donation Amount*
SAGES will charge the amount below monthly for the next 12 months.
Donor Information
Donor Name*
Prefix First Last Suffix
Institution/Organization
Is this donation personal or on behalf of an organization?*
- Personal
- On behalf of an organization
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Notes to the SAGES Foundation
Total to be charged today
$0.00
Credit Card*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Email
This field is for validation purposes and should be left unchanged.

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SAGES Member Donation History

SAGES Members can view and download their donation history by logging into the main SAGES web site and selecting “My Donations” from the members menu. Your full donation history will be displayed and there is a button to download it for record-keeping.

Contact Information

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

310-437-0544 ext 117 | Fax: (310) 437-0585 | E-mail: [email protected]

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