ACP Education Foundation

Pledge Form

Thank you for your support of the ACPEF. Please complete the below to document your commitment so that your donation may be recognized. The ACPEF will follow up with pledge payment reminders via email per the schedule you indicate below.

If you have any questions, please contact acpef@prosthodontics.org or call (312) 573-1260.

Donor(s) as name(s) should appear on recognition

Donate as Anonymous

Email (for tax receipts and pledge payment reminders)

Phone Number

Address

City

State

Zip

Country

This pledge will provide a total gift of select below to the ACP Education Foundation in support of the Drive for a Million.

Pledge

Payment Schedule

Payment Start Month

Signature
(Please type your name to confirm your pledge)

A confirmation will be sent to your email after you submit this form. Please note that payment reminder invoices are processed on approximately the 1st and 15th of every month.