ASIA | Make a Donation

Make a Donation

Making a gift to the American Spinal Injury Association (ASIA) electronically is now quick, easy, and safe. With our on-line giving form, your credit card information is safely submitted to our gift recording department for processing.

Please note that all fields marked with an * are required.

NOTE: Gifts submitted after 3 p.m. EST will be processed the next business day.

DONOR INFORMATION:
*First Name:
*Last Name:
*E-mail:
*Address:

*City:
*State:
*Postal Code:
Country (if not USA):
Home Telephone:

EMPLOYER INFORMATION: (Optional)
Double or even triple your gift to the American Spinal Injury Association! More than a thousand companies offer varying levels of corporate match for their employee's philanthropic interests. Best of all, you are recognized for the full amount of your gift plus any resulting corporate match. Check with your employer, or your spouse's employer, to see whether they have a matching gift program. Most companies require the employee to obtain the company's matching gift form (usually from Personnel or Human Resources).
Employer Name:
Title:
Address:

City:
State:
Postal Zip Code:
Country (if not USA):
Work Telephone:

GIFT INFORMATION:
I am donating to:
Gift Amount ($):
Is this a payment for a previously made pledge?
In Memory of:
In Honor of:

	In Honor / In Memory of Gift Acknowledgement Contact Information If memorial or honor gift, please notify the following person of this gift.
	*First Name:
	*Last Name:
	E-mail:
	*Street Address:

	*City:
	*State:
	*Postal Zip Code:
	Country (if not USA):
Comments:

Please be sure to review the above information for accuracy before clicking Submit.