Live Healthy Appalachia : Contact : Donate

Help us empower Appalachian communities to lead healthy lives.

Name(s) as it will appear on donor acknowledgment (Required)

Email (Required)

Donation Amount

If "Other" please use "Other Amount" field.

Other Amount

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Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Billing Zip Code (Required)

Make this a monthly payment?

Make this a monthly payment?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

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