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

This contribution is made for the following purpose*
  • Individual Membership (minimum $30 per year)
  • Individual Sustaining Membership (minimum $10 per month)
  • General Support Contribution

See below for giving selections.

Gift Information

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

The minimum on-line contribution is $10.00

Your support will be publicly acknowledged as follows:*

If you wish your contribution to be Anonymous, please indicate this in the space provided above.

Contact Information

State / Province*
Confirm Email*
Preferred Phone*

Preferred Payment Method

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


Credit/Debit Card Payment

Name on Card*
Card Number*

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