Donors may submit this form to make a contribution to the New Century Club for AAP Student Members...

AAP Foundation New Century Club Donor Form

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The American Academy of Periodontology Foundation New Century Club is a giving opportunity created exclusively for AAP Student Members.

Two levels of membership are available to Student Member donors, including a delayed invoicing option for five-year pledges of $1,000.

Yes, I want to take an active role in supporting my specialty by making a donation to the American Academy of Periodontology Foundation. Please initiate my membership in the New Century Club by sending me confirmation of my chosen giving level indicated below:

 Golden Century Membership. A five-year pledge of $1,000 total, with payments of $200/year beginning two years after my date of graduation.

Silver Century Membership. An annual invoice beginning immediately for a five-year period in the amount of:
    $25
    $50
    $100

Name 
Street address 
City 
State       Zip
E-mail address 
Periodontal Program 
Graduation date 

New Century Club donations support the AAPF Education Action Fund unless otherwise designated by the donor.



If you prefer to mail or fax this form, please send it to:
    Robert Vitas
    Executive Director
    American Academy of Periodontology Foundation
    737 N. Michigan Avenue, Suite 800
    Chicago, IL 60611
    Phone: 800-282-4867, ext. 3256 or 312-573-3256
    Private fax: 312-787-3983
    E-mail: bob@perio.org