100 Docs Campaign | United Way of the Blue Mountains

100 Docs Campaign

Think of how many lives we could touch if we raised an extra $100,000 each and every year!

100 physicians giving $1000 each year to reach a $100,000 goal!

Contribution Amount *

Total Amount

Donor Information

First Name *

Last Name *

Street Address (Home) *

City (Home) *

State *

Postal Code (Home) *

Email Address *

Phone (Primary)

Your best way to help! A gift to United Way’s Community Fund allows you to help more people than a gift to a single nonprofit. 100% of your gift stays right here in your community.

The Community Fund

United Way Community Fund

#1.Donor Choice - Agency/Amount

Recognition

If you are paying by credit card, please make sure all fields populate before checking the box "My billing address is the same as above".

Credit Card

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 *

State/Province *

Postal Code *