Online Donation | Catherine Washburn Medical Association

ONLINE DONATION FORM

Please fill out the form below and your payment will be submitted through PayPal. Note: you do not need a PayPal account, it will process any credit card.

If you prefer to donate by mail, please go to Donate Now and follow instructions.

Thank you!

CWMA DONATION AMOUNTS

Annual CWMA Membership Amount

$30 per family household

Your additional gift will make a big difference:

Maintenance and Operations Fund

Upkeep of the clinic building and grounds

Equipment Fund

Purchase state-of-the-art equipment for Lopez Clinic and LIPT (ex, X-ray machine)

Reserve Fund

Available for capital improvements or emergency needs

Sikstrom Fund

Helps Lopez patients to pay cost of care when needed

Endowment Fund

Provide perpetual income for funding major capital improvements

Special Projects

Provide funds to support special projects (ex: Pharmacy Transition)

TOTAL TAX DEDUCTIBLE DONATION *

$0.00

PERSONAL INFORMATION

Full Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone *

Would you like to be an anonymous donor?

Would you like to make this donation in someone else's name?

Total

$0.00

Notes or Questions

After you press SUBMIT below, you will be taken to a PayPal page.

You will get a confirmation email with the form info but that does NOT confirm your payment. Your donation is not complete until you get an email from PayPal, our payment processor, that your donation has been received.

NOTES: When you get to the PayPal page:

1. Choose either Donate with PayPal OR Donate with Debit or Credit Card. You do not need to have a PayPal account to pay with a credit card.

2. Credit Card Option:

If you don't want to setup a PayPal account, be sure to UNCHECK the checkmark next to "Save your info and create a PayPal account".

If you have problems with PayPal and do not get a confirmation from them, you do not have to enter the form info again. Go back to the Donate Now page and click on option #2, "To setup a Monthly Recurring Donation or complete an Online Donation". Enter the amount that you entered on your form and submit the payment.