Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund * URGENT CARE FOUNDATION TAX-DEDUCTIBLE CONTRIBUTION This Site Secured By SSL Encryption
Donation Information
Donation Amount *

Payment Method *
In Honor/Memory of
If you wish to make your contribution in honor or in memory of someone, please indicate such. Please also include contact information for the person(s) you would like us to notify of your contribution.
Non-Profit Status
The Urgent Care Foundation is a 501 (c) 3 non-profit entity, and is the singular, nationally-recognized entity devoted to the support of education, research and awareness of urgent care. The Foundation is affiliated with the Urgent Care Association of America (UCAOA). Contributions to the UCF are tax-deductible to the amount allowed by law.
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Phone *
     
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Billing Phone *

Validation Code: Answer this simple math problem to validate your submission:

Membership Management Software Powered by YourMembership  ::  Legal