Print Page   |   Your Cart   |   Sign In   |   Register
Community Search
Calendar

4/28/2014 » 4/29/2014
Otter Tail County Dental Outreach Clinic

5/7/2014
Wilkin & Richland County Dental Outreach Clinic for Kids

5/14/2014 » 5/15/2014
Otter Tail County Dental Outreach Clinic

6/2/2014
Labor Force Development Council Meeting

Donations - Secure Online Donation Form

FOR PLEDGES, please indicate pledge payment dates and amounts in the Donor Comments box. 
FOR SUBACCOUNTS, please indicate which account in the Donor Comments.

Campaign/Fund Information
Campaign/Fund * Perham Hospital District Foundation
or Select a Different Fund
This Site Secured By SSL Encryption
Donation Information
Donation Amount *
Payment Method *


Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Billing Phone *

Validation Code: Answer this simple math question to confirm you are a human:

Sign In


Forgot your password?

Haven't registered yet?

West Central Initiative is an equal opportunity provider, lender and employer.