PA EMS Foundation Online Donation

PA EMS Provider Foundation - Individual Donation Form

Develop the next generation. Educate the public. Support the welfare of providers. Thanks for your support!
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If you are supporting a specific cyclist, enter their name below.
First and Last Name of Cyclist
Type of Donation*

Support a cyclist on the memorial rideOne-time DonationSystEMS Champions (see details below)
SystEMS Champions are a special group of engaged supporters making a difference in Pennsylvania EMS with recurring gifts. SystEMS Champions provide a reliable source of support so the PA EMS Provider Foundation may stay focused on helping our EMS providers. SystEMS Champions Members Receive: A special lapel pin (with donations of at least $25 per quarter or $100 a year), invitations to special events, and listings in event programs, social media and our annual report.

If you choose this option, please include your first quarterly donation online below. After that we will charge your credit card quarterly for your support. If you have questions, contact executivedirector@aa-pa.org.

Online Donation

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Message
The PA EMS Provider Foundation is the philanthropic arm of the Ambulance Association of Pennsylvania. Thank you for your support!
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PA EMS Provider Foundation - Individual Donation Form