One Time or Recurring Donation AAHPM deeply appreciates your generous support. Please fill out the form below for your one time donation. If you prefer, make a multi-year pledge. Donor information First name* Last name* Address* City* State* Zip* Phone* Email* Gift Amount Donation Type One Time Recurring Donation frequency --Select-- Monthly Quaterly Semi-Annually Annually Number occurrences Payment amount $ Payment method Paypal Credit Card Number* Expiration Date* 01 02 03 04 05 06 07 08 09 10 11 12 / 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Card (CVV) Code* Card type* Visa MasterCard Discover American Express Card Holder Name* Bank ABA Routing Number* Bank Account Number* Bank Account Type* CHECKING BUSINESSCHECKING SAVINGS Bank Name* Account Holder Name* You will receive an acknowledgment email upon the completion of this form. * For recurring payments this field must be completed. e.g. 5 year pledge - Annual payments, please enter 5. 5 year pledge - Semi-annual payments please enter 10. Special Requests Anonymous Anonymous donation For donor recognition purposes, please list my name as: Gift Designation * Unrestricted Advocacy Workforce Education Please note: Paypal requires the most up-to-date version of web browsers for transactions. If you do not have an updated browser, you will receive a message to update your browser or choose a different one.
