Donation Form

* Required Fields

Donation Information

Amount

$1,000 - Champion for Expanding Horizons in Nursing
$750 brings UNM-G student to Doylestown Hospital
$500 provides a hearing aid for a child
$250 provides glasses for a child
$100 provides health screenings for 5 children
Other

Type of Donation

One Time Donation
Recurring Donation

Frequency

Complete the following fields if this gift is a tribute. (optional)

Type of Tribute

Tribute Name

Title

First Name

Last Name

Address

Address 2

City

State/Province

Zip/Postal Code

Contact Information
* First Name
* Last Name
Company Name
* Address
* City
* State/Province
* Zip/Postal Code
Home Phone
Cell Phone
Work Phone
* Email

Credit Card Information
* Card Holder Name

* Card Account Number
Expiration Date
* Security Code The 3 or 4 digit Security Code (CVV2) can be found on the back of your credit card. For American Express, the Security Code (CID) can be found on the front of the card.

Billing Address
Same As Above
* Address
* City
* State/Province
* Zip/Postal Code
* Email

Americans for Native Americans (ANA) is a non-profit, 501(c)(3) charitable organization.

A copy of the ANA official registration and financial information may be obtained from the Pennsylvania Department of State by calling toll-free within Pennsylvania (800)732-0999. Registration does not imply endorsement.

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Contact Us: Americans for Native Americans • PO Box 490, Doylestown, PA 18901

215.348.9293 • [email protected]