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Online Donation Form

The Albrecht Free Clinic relies solely on the generous support of donors to achieve our mission. Please know that your monetary gift will go a long way to improve the health & vitality of Washington County.

Please complete the form below. All payments are completed through Paypal.

Amount

$1,000

$500

$100

$50

$25

Donation Schedule

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(mm/dd/yyyy)

Contact Information

Name

First Name

Last Name

Business/Organization Name

Please complete if you're donating on behalf of a business or organization.

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Address

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City

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ZIP/Postal Code

Is your gift in memory of anyone?

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Is your gift in honor of anyone?

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