Florida Psychiatric Society

Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund *	FPS PAC - Protect and Strengthen Psychiatry in Florida or Select a Different Fund

Donation Information

Donation Amount *

Minimum Donation: $100.00
Silver Level: $250.00
Gold Level: $500.00
Platinum: $1,000.00
OTHER: $

NOTE:

The minimum donation amount is $100.00

Payment Method *

Credit Card

Donation Type *

One-Time Donation
Recurring Monthly Donation (until cancelled)

Donor Comments

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Card CVV Num *	What is this?
Exp. Date *	(format: mm/yyyy)
Organization
Address *
Address Cont.
City/Town *
Country *
State	(Reset)
Postal Code*
Billing Phone *