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Home / Drs. Daniel and Kathleen Clarke-Pearson Distinguished Professorship in Obstetrics and Gynecology – Pledge Form

Drs. Daniel and Kathleen Clarke-Pearson Distinguished Professorship in Obstetrics and Gynecology – Pledge Form

Please fill out the form below displaying your promise to make a gift to the Drs. Daniel and Kathleen Clarke-Pearson Distinguished Professorship in Obstetrics and Gynecology. If you have any questions, please contact to Jodie Gisser, Director of Development – Women’s Health at 919.843.9898 or jodie_gisser@med.unc.edu.

Contact Information
Name*
Prefix First Middle Last Suffix
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Gift Information
Pledged Gift Amount*
I promise to give the listed amount below to The Medical Foundation of North Carolina, Inc./UNC Medicine on behalf of Drs. Daniel and Kathleen Clarke-Pearson Distinguished Professorship in Obstetrics and Gynecology (343006).
Method of Payment*
- Check
- Credit Card (online payment)
- UNC Payroll Deduction
- Other
Please mail your check to The Medical Foundation of North Carolina 123 W. Franklin St, Suite 510 Chapel Hill, NC 27516 and add "Clarke-Pearson Professorship" in the memo line.
Please make your gift online at unchealthfoundation.org/clarkepearson. Be sure to select "Apply this payment to my existing pledge" at the bottom of the payment page.
UNC Health Care Employees - use this payroll deduction form: https://unchealthfoundation.org/ways-to-give/ways-to-give/unc-health-care-employee-giving/. Other UNC Employees - use this payroll deduction form: https://secure.dev.unc.edu/authenticate/Default.aspx?redirect=https://secure.dev.unc.edu/UDOApps/Gift_Services/Payroll_Deduction/
Payment Schedule*
- One Time (pay in full)
- Annually (max 5 years)
- Monthly (max 60 months)
How many months?*
Please enter a number from 1 to 60.
How many years?*
Please enter a number from 1 to 5.
Monthly Gift Amount*
Annual Gift Amount*
Gift Recognition
- I would like my spouse/partner to receive recognition credit
- I would like to remain anonymous
Spouse Name*
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Do you wish to make this gift through a Donor Advised Fund or through a Private Family Foundation?
IRS regulations prohibit a private foundation or a donor advised fund from making a gift toward the personal pledge of an individual. If you have a private foundation or donor advised fund and may make one or more gifts toward this commitment from it, please indicate below. A pledge can be made from a private foundation but the commitment form needs to be signed by an official of the foundation. Gifts from individuals can be made to the pledge of a foundation, but not vice versa.
- Yes - Donor Advised Fund
- Yes - Private Family Foundation
- No
Administrator:
Fund/Foundation Name:
Tribute Journal Message
How would you like your name to appear in the tribute journal?*
Quarter Page Tribute
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Half Page Tribute
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Full Page Tribute
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Need help?
- Please contact me for assistance with the tribute message
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Accepted file types: jpg, gif, png, pdf, docx, doc, Max. file size: 98 MB.
Your Promise
Consent*
By checking the box below, I confirm the details of my commitment to The Medical Foundation of North Carolina, Inc. /UNC Medicine and authorize the payment of such commitment as noted above.
I agree to The Medical Foundation of North Carolina Inc./UNC Medicine pledge form policy.
UNC Medicine is the public brand for The Medical Foundation of North Carolina, Inc. The Medical Foundation was chartered as a 501(c)3 in 1949 and does business as UNC Medicine supporting the UNC School of Medicine and UNC Hospitals. Your gift to The Medical Foundation of North Carolina/UNC Medicine supports your specific area of choice within medicine.
Signed,*
Prefix First Middle Last Suffix