Medical Delegation Donation   

	Name
	Mailing Address 1
	Mailing Address 2
	City
	State          Zip       Country
	Phone (home)
	Phone (cell/mobile)
	Email
	Amount of Donation
	What is the purpose of the donation?           Volunteer Participant ($500)              Unrestricted Donation            Education Fund            Medical/Dental            Help someone with trip expenses (put name of recipient below)
	Name of Participant you are helping
I am paying my donation by:  Online Payment Submit your donation and you will have the opportunity to complete your payment online. If you wish to use a credit or debit card we use PayPal as our payment processor. They take $0.30 plus 2.2% of each donation (e.g., $511.55 will result in a $500 donation). I will mail a check for the delegation Checks for deligation costs should be payable to The Olive Tree, Inc & mailed to: The Olive Tree, Inc c/o Virginia Scrivener, DVM 33Hebb Rd Hagerstown, MD 21740 Please hit Submit even if you are paying by check so we can send you a tax receipt. I will mail a check for the Education Fund Checks for education costs should be payable to Peace Education Fund of Indiana & mailed to: Peace Education Fund of Indiana, Inc c/o Ellyn Stecker, MD 1036 N. Niles Rd South Bend, IN 46617 Please hit Submit even if you are paying by check so we can send you a tax receipt.