The University of Iowa (U of I) Family Medicine Interest Group (FMIG), the Des Moines University (DMU) student chapter of the American College of Osteopathic Family Physicians (ACOFP) continue to promote family medicine within their school and community.
The Adopt-A-Student Campaign supports student dues as well as the family medicine student groups at each school. Your participation in the program requires your obligation of $25. This $25 pays a student member’s dues for the entire four years of medical school. Donors can choose to support students at U of I or DMU. A no preference selection will be split between both medical schools. By making your contribution to the Academy’s Foundation, your contribution is tax deductible.
Please consider promoting and supporting family medicine by adopting a student today!
YES! I would like to Adopt A student!
Name_______________________________________ Office Phone_____________________
Address_____________________________________________________________________
City, ST, Zip______________________________________________________________________
ADOPT A STUDENT:
I agree to sponsor ____ student(s) and have submitted payment by check or credit card for $ ________.
Please use my donation to support ____ U of I med student(s) ____ DMU med student(s) ____ No preference
(If none of the above is checked, it will be assumed you have no preference and will shared with both schools)
____ Please supply the student(s) with my name ____ Please do not supply the student(s) with my name.
____Pay by check *Make checks payable to the Iowa Academy of Family Physicians Foundation
100 E. Grand Ave. Ste. 170, Des Moines, IA 50309-1800
____Pay by credit card Credit Card # _______________________________________ Exp. Date __________
Signature _________________________________________ CCV Code _________
back of card
A listing of contributors will be forwarded to the U of I Dept. of Fam Med. and to Des Moines University.
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