Monthly Industry Donation - Florida for Care

This is a MONTHLY donation for an industry member as a Patient Protector.

Member is not a licensed MMTC in Florida but may not be an individual patient, caregiver or physician either

For one time donations visit floridaforcare.org/contribute and scroll down.

First Name

Last Name

Country

Address

City

Postal code

Phone

Send email updates

Employer

Occupation

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are not tax deductible.

Amount

$100 $250 $1,000 $2,000 Other $

Your credit card will be billed automatically every month

Don't publish my donation on the website.

Industry Donation - MONTHLY