OREF

Gift & Payment Information

Review Gift

ORS logo

If you have any questions or need help with this form, please
contact OREF by e-mail or phone: John Johnson 847) 430-5106

Thank you for your gift.

Amount

TOTAL GIFT--See note below.

When ORS MD members contribute up to $999.99 to the Annual Campaign, 50% of the donation will go directly to the Orthopaedic Research Society (ORS). The remaining 50% supports OREF-funded research and education.

Check this option to make this gift in honor or in memory of a loved one, and then enter the appropriate information in the fields that display.

Yes, this is a tribute or memorial gift.

Honor Gift Type: Choose the memorial gift only if the person you are honoring is deceased.

Honoree Name:

Send acknowledgement to (name): Enter the name of the person that should be contacted regarding this gift.

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Billing Information

Title:

First Name: Required A first name is required.

Middle Name:

Last Name: Required A last name is required.

Suffix:

Street 1: Required A street address is required.

Street 2/ Organization:

City: Required A city is required.

State/Province: Required A state or province is required.

ZIP/Postal Code (if no code, enter 000): Required A zip or postal code is required. If you do not have a code, enter 000. A zip or postal code is required. If you do not have a code, enter 000.

Country: Required Billing country is required.

Email Address: Required An email address is required.

For your privacy, subscribers can unsubscribe using any email or login to change communication preferences.

Yes, I would like to receive communication from this organization.

Preferred Mailing Address

Check this box if the billing information and the preferred mailing address are the same.

Use the billing information as the preferred mailing address.

Title:

First Name: Required Donor first name is required.

Middle Name:

Last Name: Required Donor last name is required.

Suffix:

Street 1: Required Donor street address is required.

Street 2/ Organization:

City: Required Donor city is required.

State/Province: Required Donor state or province is required.

ZIP/Postal Code (if no code, enter 000): Required A zip or postal code is required. If you do not have a code, enter 000. A zip or postal code is required. If you do not have a code, enter 000.

Country: Required Donor country is required.

Check this box if you want this site to remember you when you return.

Remember Me

Please enter your name (may include spouse/partner) as you would like it to appear when recognized. Contributors are recognized in the Annual Report and at the OREF Exhibit at the AAOS Annual Meeting.

Payment Information

Select a Payment Type: Required A payment type selection is required. Payment options are credit card or bank account withdrawal.

Credit Card Type:

Visa

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American Express

MasterCard

Credit Card Number: Required Credit card number is required.

CVV Number: Required CVV number is required.

What is this?

Select month of credit card Expiration Date: Required Select Expiration Year

Bank Routing Number: Required Bank routing number is required.

What is this?

Bank Account Number: Required Bank account number is required.

Verify Bank Account Number: Required Bank account number is required.

Account Type: Required Required

	Checking
	Savings

Required Bank account withdrawal confirmation is required.

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.