Donate to DAPS!

We are a donation-supported organization. Your donation helps fund our many groups, classes, and educational meetings which we offer at no cost to those in our community who are affected by Parkinson's disease.

Contribution Amount

$ 25.00

$ 50.00

$ 100.00

$ 250.00

$ 500.00

Other Amount

Other Amount $

Email Address *

I am contributing on behalf of an organization.

Organization Details

Organization Name *

Phone

Email *

Address

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Donor Name and Address

Please list the donor name as you would like it to appear in acknowledgment letters and/or in our newsletter.

First Name

Last Name

Address (Home)

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State (Home)

Postal Code (Home)

Country (Home)

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

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Postal Code *

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