Donors may submit this form to make planned and estate gifts to the Foundation...

AAP Foundation Visionary Society Commitment Form

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Membership in the Visionary Society is open to donors who submit this commitment form indicating their intention to make an estate or planned gift to the AAP Foundation.

I plan to make a commitment to my specialty and hereby enroll as a member in the AAP Foundation Visionary Society. The Foundation will receive official documentation of my gift on or about:
    Date

Please recognize this commitment as follows (i.e. Dr. and Mrs. John J. Smith):

    Name for publication
    I do not wish to have my name or gift publicized. Please list me as “Anonymous”

I would like for my future gift to support:

    Dr. Gerald M. Bowers Endowment Fund for the American Board of Periodontology
    Bud and Linda Tarrson Fellowship
    Abram and Sylvia Chasens Teaching and Research Fellowship
    Dr. and Mrs. Gerald M. Kramer Scholar Award for Excellence
    New Educational Initiatives
    Education Action Fund
    Charles Finley Visiting Scholar Award
    Use my gift for what the Board of Directors determines are the most critical needs

I prefer to be contacted regarding my gift at the following mailing address, telephone and/or e-mail address:

    Street address 
    City 
    State       Zip
    Phone number 
    E-mail address 

Please describe your gift:

All submitted information will be held in confidence.




If you prefer to mail or fax the commitment 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