Donation Information
$
Profile/Billing Information

All fields marked * are required.

California Physicians Only
Payment Options
PayPal Checkout You will be redirected to the PayPal website to complete the order.

Please complete and submit this donation form when donating to #ThisIsOurShot via check. If you are unable to print the form, please include all information on or with the check and follow the directions on this form.

Please click here to open the check donation form.

Billing Information

Physicians for a Healthy California is a registered IRC 501(c)(3) non-profit organization (Tax ID 94-6062822). Your donation is tax deductible to the extent allowed by law. No goods or services were provided by Physicians for a Healthy California in return for this contribution.

By checking this box, you acknowledge you have read and agree to be bound by our Privacy Policy and Terms of Service, and you are authorizing your credit card to be charged for the indicated amount.

The following required fields are missing: