Charitable Donation Form

Donation Amount in US$

Important note:

In order to maximise donations and ensure we do not incur bank or card charges that exceed the donation amount, there is a minimum donation of US$5.00. Please change the amount above. Thank you for your support.

If you would like your donation to be spent on a specific area of work or project, such as RDTC or DermLink grants, please specify below.

Your Information

First Name

Last Name

Email Address

Phone Number

Can we contact you about the work of ILDS in the future?

YesNoAre you happy for the ILDS team to contact you in regards to your donation and other support opportunities?

Payment

Donation Amount

Credit Card Information

Name on Card

Card Number

CVV Code

Billing Email

Billing Address

City

Country

State

Province

Zip Code

Contact Information