Donations - Secure Online Donation Form

Please check your tax code for deduction possibility.

United States Tax Deduction:
Please keep your receipt which confirms, as required by IRS Regulations for US Code 501(c)(3) organizations concerning donations, that no goods or services were received or provided in exchange for this gift.

To Donate through the mail print this form.

Campaign/Fund Information
Campaign/Fund * ADI Foundation-General
or Select a Different Fund
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Donation Information
Donation Amount *

     
Payment Method *
Donation Type *


Number of Payments *  
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Billing Phone *

Validation Code: Answer this simple math problem to validate your submission:

Contact

Academy of Dentistry International®
3813 Gordon Creek Drive
Hicksville, Ohio 43526 U. S. A.
Tel: + 001(419) 542-0101
Fax: +001(419) 542-6883
Email:info@adint.org