Make a Donation - Research and Education Foundation of the American Head and Neck Society

Donor Name*

First Middle Last

Email*

What kind of donation would you like to make?*

One-time Gift or Single Pledge Payment (up to $5,000)

Monthly Recurring Gift

Annual Recurring Contribution

Your first payment will be charged immediately, and subsequent payments charged monthly until you cancel. You will receive an email notification before your next payment that will allow you to edit the recurring contribution. You may also cancel by emailing julia@ahns.info.

Your first payment will be charged immediately, and subsequent payments charged annually until you cancel. You will receive an email notification before your next payment that will allow you to edit the recurring contribution. You may also cancel by emailing julia@ahns.info.

Donation

Is this a Centurion Club Donation?*

The Centurion Club recognizes consistent robust giving among AHNS members. Centurion Club gifts can be directed to any of the funds indicated below. Donors in their first five years of practice qualify for the Centurion Club with an annual $500 gift. Those who have been in practice more than 5 years qualify with an annual gift of $1000. This invaluable support helps the Foundation fulfill its commitment to funding head and neck cancer education and research.

Yes, Centurion Club $1,000 (>5 years of practice)

Yes, Young Centurion Club $500 (<5 years of practice)

No, this is not a Centurion Club donation or I would like to give another amount

Is this a Five-In-Five Pledge?*

The Five-in-Five campaign provides the opportunity for AHNS leaders and others with a passion for improving head and neck patient care to make high level gifts to the Foundation in the amount of $5,000 annually for five years. These generous donations help the Foundation to consider new initiatives and expand its reach. Five-In-Five donations can be directed to specific funds (See below)

Yes, I'd like to give $5,000.

One-Time Gift Amount*

A single donation made to the Foundation which will assist with our annual fundraising efforts. These gifts may be made in memory or honor of someone.

Monthly Gift Amount*

Annual Recurring Contribution Amount*

How would you like to direct your donation?*

General Fund

In Someone's Honor

In Someone's Memory

40 in 4 Campaign (Goal: to amass 40 '5 in 5' donors in 4 years)

Eduardo Méndez Diversity Summer Fellowship

Area of greatest need

The Myers Family Minority Student Summer Fellowship offers trainees from traditionally under-represented minority backgrounds the chance to work in a Department of Academic Excellence in Head and Neck Surgical Oncology that has an approved Fellowship Training Program from the Advanced Training Council of the AHNS.

Donation to the Young Investigator award will provide up to $20,000 annually to a head and neck fellow or assistant professor pursuing research in neoplastic diseases of the head and neck.

On January 5, 2018 our esteemed colleague, Dr. Eduardo (Eddie) Méndez lost his courageous two and a half year fight against cancer. Eddie dedicated his entire career to the treatment of Head and Neck cancer, and he improved the lives of countless patients with head and neck cancer through his surgical abilities and his research advances.

As a leader in the AHNS, Eddie served as the Co-Chair of the Diversity Task Force. Upon learning of the Myers’ Family generous gift to establish the Myers Family Summer Diversity Fellowship, Eddie initiated a campaign to establish a second fellowship. Upon his passing, the AHNS and Foundation leadership dedicated the second fellowship in Eddie’s honor by naming it the Eduardo Méndez Diversity Summer Fellowship.

The goal of the campaign is establish a fund within the Foundation, the annual proceeds from this fund will support a fellowship for a medical student to spend a summer under the mentorship of an AHNS member. The intention of the Fellowship is to encourage medical students from diverse backgrounds to pursue careers as head and neck cancer surgeons.

Honoree Name*

First Last

Reason for Donation

Other

Would you like us to notify the honoree of your donation?*

Yes

Honoree Email

Honoree Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

In Memory of*

First Last

Would you like us to notify the family of the deceased regarding your donation?*

Yes

Family Contact Name*

First Last

Family Contact Email Address

Family Contact Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Would you prefer to be identified or remain anonymous?*

Identify Me

Anonymous

Please give us the contact information for the honoree, if you have it.

Total to be Charged Today

Credit Card*

Institution

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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