Making a Difference

James Libby Memorial Fund

World Health Dental Organization Donation Form

Contribution
Contribution of Funds*
Please indicate how you would like your donation to be applied:
Contact Info
First Name*
Last Name*
Email*
Phone
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Generous Donation
Donation Amount*
- $100
- $250
- $500
- $1,000
- Other Amount
Choose how much you would like to donate.
Other Amount

Choose a custom donation amount.
Donation Type*
- One Time
- Monthly
Credit Card Information
Credit Card*

Card Details

Cardholder Name
Total
$0.00

Additional Ways to Donate

To send donations by check

Make checks payable:
World Health Dental Organization

Mail to:
World Health Dental Organization
Box 107
2023 East Sims Way
Port Townsend, WA 98368

Making a Difference

James Libby Memorial Fund

World Health Dental Organization Donation Form

Contribution

Contact Info

Your Generous Donation

Credit Card Information

Additional Ways to Donate

To send donations by check

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