Donate It's time to take action – but we can’t do it without your help! Donate to Children's Health Defense - Oregon Chapter We are a 501(c)(3) non-profit organization. Donations are tax deductible to the full extent of the law. Our EIN is 86-2056360. Please contact us if you need assistance with donation or have any questions. This form is for a one-time donation. You can also make a recurring donation. Other donation options: Donate by check Make payable to Children’s Health Defense - Oregon Chapter Mail to: Children’s Health Defense - Oregon Chapter 258 A Street, Suite 1, #479 Ashland, OR 97520 Authorize a bank transfer Open a donor advised fund Thank you so much for opting in to our mailing list! Your support is critically important to Children's Health Defense's justice initiatives. Children's Health Defense is a 501c3 non-profit organization. Donations are tax deductible to the full extent of the law. If you have any problems with this form or questions about donating, please do not hesitate to contact us. One-time Donation FormName* First Last Email* Opt in for Newsletter & Updates Add me to your email list This field is hidden when viewing the formAre you a CHD member?Please let us know if you are already a member. Yes, I'm already a member. Not yet; I'd like to become a member. No thanks. Would you like to donate in honor/memory of another person? Yes Add name of person to honor/memorialize.*Would you like to send notice of the donation to another recipient?* Yes No thanks Name of Recipient* First Last Email of Recipient* Message to Recipient Donation Amount*Please enter your amount. Membership Options* $10 Membership Fee $10 Membership Fee + additional donation Membership Fee Price: Any Additional Donation AmountPlease enter your amount. This field is hidden when viewing the formPayment Options*Most cards and currencies from throughout the world are supported. Any credit/debit card PayPal (use your account or credit/debit card) Credit Card*Card Details Cardholder Name You will be transferred to PayPal after you select the Submit button at the end of this form.Total Where are you located?* United States Outside of United States US PhoneSMS - Text Messages I agree to receive text messages from CHD. Msg/data rates may apply. You can opt out at any time.Int'l PhoneSMS - Text Messages I agree to receive text messages from CHD. Msg/data rates may apply. You can opt out at any time.Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Address* Street Address City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Optional: Demographic InformationTo determine how you may be able to help in our legal efforts and initiatives, we are requesting demographic information about you and your family. This field is hidden when viewing the formYour Age 18-25 Years 26-45 Years 46-65 Years 66+ Years This field is hidden when viewing the formDo you have any children in these age groups? Newborn - 2 years 3-12 years 13-18 years Young Adult None This field is hidden when viewing the formWhat is your occupation? Attorney Medical Professional Dental Professional Journalist Marketing Other This field is hidden when viewing the formWould you like to become a CHD volunteer? Yes No This field is hidden when viewing the formIn what areas would you like to volunteer? Fundraising Writing Clerical Social Media Legal Marketing/Lists Research/Treatment Advocacy Website Video Production Other (please detail below) This field is hidden when viewing the formPlease tell us about any special talents that you could provide as a volunteer?Our promise to you: Your personal information will only be used by Children's Health Defense. Thank you so much for supporting Children's Health Defense!This field is hidden when viewing the formDateThis field is hidden when viewing the formSourceCommentsThis field is for validation purposes and should be left unchanged. Δ If you have any problems with this form or questions about donating, please do not hesitate to contact us.
