Medical Delegation 2016 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

Checks 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.