Please note that fields with an asterisk (*) are required. 

This contribution is made for the following purpose*
  • General Operating
  • Individual Membership (minimum $30)
  • Organizational Membership

Gift Information

Donation Amount*
  • $30
  • $50
  • $100
  • $250
  • $500
  • Other $

The minimum on-line contribution is $10.00

Your contribution will be publicly acknowledged as follows:

Leaving the above field blank means we will use your name for public acknowledgement purposes. If you wish your contribution to be Anonymous, please indicate this in the space provided above.

Contact Information

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Tribute Information (optional)

In honor of
In memory of

Please send an acknowledgement of this contribution in honor/memory of to:

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If contributing by check, please make your check payable to Health Care for All-Oregon (or HCAO)

and send it to us at the following address:  


1443 SE 122nd Avenue

Portland, OR 97233



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