CiviContribute | Network PAAO

I would like to be a member of the Circle of Vision with my gift of $1,000 or more

Partner Member - $ 1,000.00

Patron Member - $ 2,500.00

Leader Member - $ 5,000.00

Ambassador - $ 10,000.00

Visionary - $ 25,000.00

Other Amount

Other Amount $

Total Amount

Circle of Vision Member

First Name

Last Name

Email Address

Phone

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Gifts to the Pan-American Ophthalmological Foundation (PAOF) are tax deductible as provided by law. The Foundation is a 501(c)(3) not-for-profit organization. The tax ID is 94-2733047.