Join the Wiegenstein Legacy Society

Please complete this online form to join. We will recognize your generous spirit by including your name on the WLS donor wall inside the EMF Wiegenstein conference room at the ACEP headquarters

Name

Address

City

State

Zip code

Phone

I have provided for the Emergency Medicine Foundation in my estate plans

Type of Planned Gift

Bequest

Trust

Life Insurance

Retirement Plan

Other

If other please provide detail

The purpose of my gift is:

Unrestricted to meet the most pressing needs of EMF

Restricted

If restricted, please specify (i.e. scholarship, program of your choice):

The current value of the gift is

I/we give consent for my/our name/s to appear with others on the WLS donor wall

I/we wish to remain anonymous

I/we wish my/our name/s to appear as:

You are limited to two credentials after your name

I agree to join the Wiegenstein Legacy Society

SUPPORT
EMERGENCY
Medicine
RESEARCH

Donate

Donate to EMF while you shop with

Phone: 800-798-1822

Support EMF
Donors and Partners
Grants
- Apply for a Grant
- Directed Research Grants
Grantees
- Current Grantees
- Past Grantees
Events
About EMF
Donate