Donation Form

Phone: (901) 527-3018
Fax: (901) 528-1972
Toll Free: (800) 767-3018

Thank you for your interest in Mid-South Paralyzed Veterans PVA. If you would like to consider making a contribution now, please fill in the fields below, then press "Submit My Donation."

This gift is from:

661-555-5555

Donation Types

  1. General Donation
  2. In Memory Of
  3. National Veterans Wheelchair Games - Your donation will help send a veteran to the National Veterans Wheelchair Games. This event is sponsored by Paralyzed Veterans of America and Veterans Affairs. This year the games are in Dallas, Texas. This can be very costly to a disabled veteran and your donation counts! Thanks for your consideration.
$25 $50 $100 $250 Other

Please notify the following person that this gift has been made to Mid-South Paralyzed Veterans PVA

661-555-5555

Please check that all parts of the form above have been completed and then press "Submit My Donation" only once. The confirmation page will appear shortly afterwards. Then you will be able to proceed to enter your billing information and process the donation through Authorize.net.

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