Our Online Donation Form allows you to make contributions to The Foundation for Post-Acute and Long-Term Care Medicine, Wall of Caring, and the Foundation's Futures Program by allocating your donation amount across one or more categories.  All online contributions are processed by our secure PayPal site.

You may wish to review the Contribution Levels below.

Contribution Levels

Contribution Levels
Level Range
Supporter $25 - $99
Friend $100 - $249
Patron $250 - $999
Charter $1,000 - $4,999
Leader $5,000 - $9,999
Champion $10,000 and above

Internet Explorer Users:

We recommended that you submit our forms using a modern compliant browser such as an up-to-date version of Chrome, Firefox, or Safari and avoid using MS Internet Explorer, especially older versions, which present some compatibility problems.

Contributing to the Foundation for Post-Acute and Long-Term Care Medicine - Online Donation Form

Contributor's Information

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The information on this page pertains to your personal information.

First Name(*)
Please provide your full name.

Middle Initial
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Last Name(*)
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Please list credentials separated by commas.

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Please type your full name.

Invalid email address.

AMDA Member(*)
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Are you an AMDA member?


Donation Preferences

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The information on this page pertains to your donation preferences.

Listing Option(*)
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Select to include your name if you'd like your name to appear in our list of contributors. Select to exclude your name if you're making an anonymous donation.

Matching Option
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Indicate whether your employer has a matching gift program or not.


Donation Selection

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The information on this page pertains to your donation specifics.

Total Donation
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Note the minimum Total Contribution shown above must be at least $25.



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The information on this page pertains to the verification and security of your submission.

Captcha   RefreshInvalid Input

Type the four lower case characters shown in the box above on the left into the box on the right and click Submit. You may click the Refresh link above as many times as you need to until you're confident you see the letters clearly.