Support the Baylor College of Medicine Employee Emergency Relief Fund

This February, people throughout the Houston area community experienced an extreme arctic cold front with historic low temperatures, causing widespread and extended disruption of the power and water supplies. This disaster has affected the entire population, and Baylor employees are no exception. If you would like to support our Baylor employees who suffered damage to their homes from broken water pipes, please fill out the form below.

Thank you!

To prefill your form, please login now.

No social media sites were configured for login.

Help

Required Asterisk Example = Required fields

Field Is Required Select Gift Amount:

$25.00

$50.00

$100.00

Other

Enter amount

Gift type:

One-time gift

Recurring gift

Select a Gift Duration:

Total Gift: 0.00

Field Is Required Gift Designation:

Use my gift where it is needed most.

Direct my gift to:

If you chose to write in a designation not listed, please specify:

Yes, I would like to make this donation anonymously

Honor/Memorial Information

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Your First Name:

Your Last Name:

Would you like us to mail a card acknowledging your gift?

Yes, please send a card on my behalf

Acknowledgee Name:

Acknowledgee Address:

Acknowledgee Suite/Apt:

Acknowledgee City:

Acknowledgee State:

Acknowledgee ZIP:

Billing Information

Yes, I would like to make this gift on behalf of an organization or company.

Organization Name:

Title:

First Name:

Last Name:

Street Address:

Apt/Box/Unit/Suite:

City:

State/Province:

ZIP/Postal Code:

Billing Country:

Email Address:

Will your company match your gift? Please enter the name below:

BCM Affiliation

If you donate and have not already registered, you will receive periodic updates and communications from Baylor College of Medicine.

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?