HEALS Holiday Giving

A Gift for the Children of HEALS

Donation Amount*
  • $50 - A month of Dental care for 3 or Medical care for 4 children
  • $100 - A month of Medical, Dental, & Optometry care for 3 children
  • $400 - A year of Medical, Dental, & Optometry care for 1 child
  • $800 - A year of Medical, Dental, & Optometry care for 2 children
  • $1,200 - A year of Medical, Dental, & Optometry care for 3 children
  • Other $

Gift in Tribute

If you choose to give your Holiday Gift as a Gift in Tribute, please complete this section.

Tribute Name
Notification Name
Notification Address

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code

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