Monthly Donation Form

SETUP A MONTHLY DONATION USING YOUR CREDIT CARD

If you would like make a one time donation ? ONE TIME DONATION FORM

Your Name*

First NameLast Name

Phone Number*

E-mail*

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Dedication Type

Dedicate Donation

First NameLast Name

Would you like to make a one time donation? One-Time Donation Form

My Donation*

One Dollar A Day($30.00 for each month)

Two Dollars A Day($60.00 for each month)

Custom Donation(USD for each month)

Email

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Tax Exemption Notice: The AAMD Foundation is the a tax-exempt 501(c)(3) organization under the Internal Revenue Service tax code. Your contribution is tax-deductible. You will receive a tax notice via email.

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