Step 1
Gift Information
 
             
Step 2
Payment Information
 
             
Step 3
Review Gift
 

Thank you for supporting the work of the American Lung Association through your gift.  This form is designed to help you are honor the life of a departed friend or relative. 

If your donation is to celebrate a milestone in the life of someone who is still alive, please return to the donation page and choose the celebratory gift option.  Your donation will make a difference in the Fight For Air. 

If you have any difficulties or questions about this form, please contact us at midland@midlandlung.org.

Honoree Information

This donation form is for memorial gifts, donations given in honor of someone who has passed on.  If you wish to make a celebratory gift honoring a special occasion, please return to the donation page and select the celebratory donation form.

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Gift Information
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Who should we notify about your gift? (e.g., a member of the deceased's family) Full address please.
 
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