Donate to the Parkinson's Foundation Minnesota & Dakotas Chapter

Please Note: Fields marked with an asterisk (*) are required

How would you like to donate?

Additional Amount:

Is this gift in honor or in memory of someone?

Yes, this is an honor or memorial gift

Honor Gift Type:

Yes

In Honor

In Memory

Make my gift in honormemory of:

First Name:

Last Name:

Card Type Send an E-Card

Send a Print Card

Recipient email addresses:

Select an eCard:

eCard Subject:

eCard Message:

Recipient Name:

Address:

Notification Recipient Street 2:

Zip:

City:

State:

Country:

Special Instructions:

Your Information:

Title:

First Name:

Last Name:

Address:

Street 2:

City:

State:

Zip:

Country:

Email:

Mobile Phone:

You’ll receive email updates from us. You can unsubscribe at any time.
By providing your mobile phone number, you agree that we can contact you regarding important updates for the Parkinson’s Foundation Community.

Payment Information:

Payment Method:

Credit CardBank Account

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Bank Account Withdrawl:

Bank Routing Number: What is this?

Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Check Information

Processing Fee YesNo

Yes

If you would like to make a donation by mail, please complete this form and send to:

Parkinson’s Foundation Minnesota & Dakotas Chapter
Attn: Donor Services
5757 Waterford District Drive
Suite 310
Miami, FL 33126