Thank you for your interest in the COVID-19 Heroes Campaign. This will be a two-step process:

1. Submission of your donation type and relevant information.

2. Submission of your payment information through APhA's website.

This online form will capture your specific donation information and depending on any additional campaign elements attributed to your donation amount.

Funds given to this campaign will be apportioned into an unrestricted fund to maintain and implement future elements of the campaign and a restricted fund to maintain pavers for up to 10 years.

The American Pharmacists Association Foundation is a 501(c)(3) nonprofit organization, EIN: 52-6039142. Your contribution is tax-deductible per current Internal Revenue Service regulations.

Donor Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

You may contribute to this campaign at different levels where based on your donation amount, you will be eligible for different levels of acknowledgment. Please review these levels to determine your preferred level of contribution to the COVID-19 Heroes Campaign.

$1 - $499 (Direct Support)

Provide direct support to the campaign and you will be acknowledged as a donor to the Foundation in the Annual Report.

$500 - $999 (Direct Support and Plaque Recogntion)

Provide direct support to the campaign and you will be acknowledged on a bronze recognition plaque to be installed inside the APhA Headquarters along with in the Foundation's Annual Report.

$1,000 per 8" x 8" paver (Direct Support, Plaque Recogntion, 8x8 inch Paver)

Provide direct support to the campaign, acknowledgment on a bronze recognition plaque to be installed inside the APhA Headquarters along with in the Foundation's Annual Report, and selection of an 8" x 8" inscribed paver to be maintained with campaign funds for up to 10 years.

$5,000 per 32" x 16" paver (Direct Support, Plaque Recogntion, 32x16 inch Paver)

Provide direct support to the campaign, acknowledgment on a bronze recognition plaque to be installed inside the APhA Headquarters along with in the Foundation's Annual Report, and selection of a 32" x 16" inscribed paver to be maintained with campaign funds for up to 10 years.

$15,000 per bench (Direct Support, Plaque Recogntion, Bench dedication)

Provide direct support to the campaign, acknowledgment on a bronze recognition plaque to be installed inside the APhA Headquarters along with in the Foundation's Annual Report, and selection of a bench overlooking the eastern lower terrace engraved with your submitted inscription. (Only two available. Please inquire)

Please email info@aphafoundation.org if you would like to support the campaign in a way other than the options above.

Please select one of the options below to identify which way you wish to support the COVID-19 Heroes Campaign: *

$1 - $499 (Direct support)

$500 - $999 (Direct support and recognition on bronze plaque)

$1,000 per 8x8 paver (Recognition on bronze plaque and a 8x8 inch engraved paver)

$5,000 per 32x16 paver (Recognition on bronze plaque and a 32x16 inch engraved paver)

Please select your preferred method for submitting your donation: *

Outright (one-time payment)

Pledge (payment in installments)

Do you plan for your donation to be part of a matching gift? *

Yes

No

Please name the intended company or organization that will be providing a matching gift, on your behalf? *