2024 ElevateMeD Anniversary Donation

{{profilePhoto.url?'':accountBasicInfo}}
- MY PROFILE
- Dashboard
- Log out

{{formatAmount(campaignStats.goalMeter.raisedAmount)}} Raised

Goal {{formatAmount(campaignStats.goalMeter.goalAmount)}}

{{campaignStats.goalMeter.raisedPercentage}}%

Raised

{{campaignStats.goalMeter.donorCount}}

Donors

{{campaignStats.goalMeter.registrantCount}}

Registrants

{{formatAmount(campaignStats.goalMeter.raisedAmount)}}

RAISED OF {{formatAmount(campaignStats.goalMeter.goalAmount)}}

{{campaignStats.goalMeter.raisedPercentage}}% RAISED

{{campaignStats.goalMeter.donorCount}} Donor{{campaignStats.goalMeter.donorCount > 1 ? 's':''}}

{{campaignStats.goalMeter.registrantCount}} Registrant{{campaignStats.goalMeter.registrantCount > 1 ? 's':''}}

Let's end disparities in healthcare together.

1

{{pageTitles[currentPage-1]}}

2

{{pageTitles[currentPage-1]}}

3

{{pageTitles[currentPage-1]}}

Donors will be recognized on ElevateMeD website, marketing materials, and social media channels.

4

{{pageTitles[currentPage-1]}}

5

{{pageTitles[currentPage-1]}}

Donate Once {{handleFrequencyLabel('1m', 'Donate Monthly')}}

{{item}}

Other Amount

Other Amount

{{donationOtherAmountLabel}} *

USD

{{item}}

{{item}}

{{item}}

Campaign

{{item}}

Dedicate my donation in honor or in memory of someone

{{item}}

Type

Honor

Memory

{{item}}

{{item}}

Tribute Name

{{item}}

Salutation

{{item}}

I would like to send an acknowledgment to someone.

{{item}}

Acknowledgee Name is the same as the Recipient.

{{item}}

Acknowledgee Prefix

{{item}}

Acknowledgee Name

{{item}}

Acknowledgee Suffix

{{item}}

Acknowledgee Email

{{item}}

Acknowledgee Phone

{{item}}

{{item}}

{{item}}

{{item}}

Anonymous Donation

{{item}}

Donor Note

{{item}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

First Name *

{{item}}

Last Name *

{{item}}

Prefix

{{item}}

Suffix

{{item}}

Submit as a company

{{item}}

Company Name

{{item}}

Job Title

{{item}}

Email *

{{item}}

Website

{{item}}

Address Line 1 *

{{item}}

{{item}}

{{item}}

Address Line 2

{{item}}

City *

{{item}}

State/Province *

{{item}}

Zip/Postal Code *

{{item}}

Country *

{{item}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Website Donor Recognition

OPT OUT

{{item}}

If you prefer not to have your name published on https://www.elevatemed.org/donors please check this opt out option.

{{item}}

Website Display Name

Please list your name how you would like it to appear on the published ElevateMeD Donor's List. Please include your spouse's/partner's name and salutation if donation is from a joint household. ex: Drs./Dr./Mr./Mrs./Ms.

{{item}}

Contribution Type

{{item}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Where did you hear about us?

ABC 15

AZ Central

Facebook

Google

Instagram

LinkedIn

School

Twitter

Walton Isaacson

Youtube

Other

{{item}}

{{item}}

Other Source

If you selected other, please tell us how/where you learned of ElevateMeD for the first time.

{{item}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Card

ACH

{{cardDonorCoveredFeeDesc}}

or enter your card details below

Cardholder First Name *

{{item}}

Cardholder Last Name *

{{item}}

Cardholder Email

{{item}}

Card *

{{item}}

Billing address is the same as mailing address

Address Line 1

{{item}}

Address Line 2

{{item}}

City

{{item}}

State/Province

{{item}}

Zip *

{{item}}

Country

{{item}}

{{cardDonorCoveredFeeDesc}}

{{achDonorCoveredFeeDesc}}

{{ccfpInfo.notInGoodMessage || ''}}

{{ccfpInfo.notInGoodMessage || ''}}

{{item}}

Data Privacy & Consent

Yes, I would like to receive communications from ElevateMeD by SMS. I agree to receive promotional message sent via autodialer. This agreement isn't a requirement for any purchase or contribution. You may receive 4 msgs/mo. You may opt out at anytime. Reply STOP to end or HELP for help. Terms & Privacy Policy can be found at elevatemed.org/terms. Standard text message rates may apply.

Amount:

{{donationAmountStr}}/{{recurringUnitText}} USD

{{cardTotalAmountIncludeFeeList}}

Secure Payment

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Privacy Statement | Terms of Service

Your email has been submitted. If that email address exists in our system, you should receive a recovery information email shortly. If you do not receive an email, please check your spam folder. If you still don't receive an email, then there is no account associated with the submitted email address.

Log in to your existing account

{{errMsg}}

Login Name:

Password:

Or sign in with

Forgot your password?

Enter the e-mail address associated with your account and we'll send you a link to recover your login information.

Email:

Please enter a valid email address

ACH Payment Confirmation

Verify that your bank account information is accurate.

Total Amount

{{formatAmount(totalAmount)}}

Routing Number

{{hideAchNumber(formData.payment.ach.routingNumber)}}

Bank Account Type

{{Number(formData.payment.ach.accountType) === 2? 'Checking' : 'Saving'}}

Bank Account Number

{{hideAchNumber(formData.payment.ach.accountNumber)}}

ACH payments may take up to 10 days to appear on your bank account statement.