Pledge Form

Sponsorship Opportunities

Foundation Benefactors
I pledge to become a:
Sustaining Benefactor $50,000  
Contributing Benefactor $30,000 
Supporting Benefactor $40,000  
Benefactor $25,000
Supporter $12,500 Patron $10,000
 
A Tribute to Former County Commissioner Pat Glass
(Ticket only)
Please reserve:
  Table Ticket(s) for $1,000     Individual Ticket(s) for $100   
General Donations

I pledge: 

To make a tax-deductible contribution of  $ to support the FHCCM Foundation's initiatives in the expansion of access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvement in the health status of the people in the Manatee County Rural Health Service Area.
Please fill out all the fields below and click Submit.   Please note that all fields are required fields.
Name:
Title:
Company:
Address:
City: 
State: 
Zip: 
Email:
Phone:
Fax:
 Logistics Contact
Contact Information the same as above
Name:
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  Please enter security code exactly as shown.


The FHCCM Foundation, Inc. is tax-exempt under IRS Code 501(c)(3). 




Open / Download Form
Downloadable Pledge Form
For more information about Family Health Care Centers of Manatee Foundation, please use one of following options:

Telephone: (941) 752-6588

Email: Charlie Wells, Executive Vice-President of Foundation and Intergovernmental Affairs


Sylvia Camarena, Special Executive Assistant


Shawny Robey, Marketing and Public Relations Director