Grand Rapids African American Health Institute · Pathways General Donation Form

One moment please...

Please provide your contact and payment information below. Your contact information is required to generate a tax receipt which will be sent to the email or address provided.

Amount *
$1,000
$500
$250
$100
$50
$20
$10
$5

Donation Schedule

Contact Information

Name *

First Name

Last Name

Phone

Email *

Verify Email *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Is this a company donation? Please list name of company/organization if so:

Name (Optional)

Is this gift in honor or in memory of an individual?

In Memory Of

In Honor Of

Add 3% to my total amount to help cover the payment processing fees