If you would like to donate by Check, please mail your donation to MEDICO at 2955 Dawn Drive, Suite 104 Georgetown, TX 78628

First Name

Last Name

Phone

Address

Street

City

State

Country

Provinces

State/Province

Postal Code

I would like to donate via

Credit CardPaypal

Paypal Quantity

Stripe Quantity

Donation Amount

I would like to cover a 3% processing fee associated with my donation

Charge Amount

Payment Information

Charge Amount

Credit Card Number

CVV Code

Dedication

I would like to make this gift in Honor/Memory of someone

In honor ofIn memory of

Honoree Name

I would like MEDICO to notify the honoree (or their acquaintance) about this gift via

EmailPostal MailNo notification is required

Notification Recipient Name

Notification Recipient Email

Notification Recipient Mailing Address

Paypal_Hidden_Fields