Every six minutes, someone is diagnosed with PD.

You can help APDA provide the support, education, and research that will help everyone impacted by Parkinson's disease live life to the fullest.

1. Your Gift

Field Is Required Select gift amount: (minimum gift amount $5.00)

$50.00

$100.00

$250.00

$500.00

$1,000.00

Other

Enter amount

Frequency:

One-time

Monthly

Select a Gift Duration:

Yes, this is an honor or memorial gift

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Would you like to send a notification by mail or email?

By mail

By eCard

No thank you

Notification Recipient Name:

Recipient Street 1:

Recipient Street 2:

Recipient City:

Recipient State/Province:

Recipient ZIP/Postal Code:

Recipient Country:

Yes, I would like to send an eCard.

Recipient email addresses:

Select an eCard:

eCard Subject:

eCard Message:

Yes, send me a copy of the eCard.

2. Donor Information

First Name:

Last Name:

This is an organization gift

Yes

Organization Name:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal code:

Country:

Phone Number:

Email Address:

Please keep me informed of the American Parkinson Disease Association's efforts via email

Please text me information and news from the American Parkinson Disease Association

Yes

3. Company Matching

Does your employer have a corporate matching gift program? Please use the field below to search if your employer will match your personal donation. If this does not apply to you, please skip this section.

4. Billing Information

Use the donor information as the billing information

First Name:

Last Name:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Country:

5. Payment Information

Payment Method:

Credit/Debit CardChecking Account

Credit Card Information:

Credit Card Type:

Credit/Debit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Checking Account Information:

Bank Routing Number: What is this?

Bank Account Number:

Verify Bank Account Number:

Account Type:

Checking
Savings

By checking this option, I agree to use my bank account as a payment method and authorize this organization to debit my bank account to fulfill my donation commitment.

Check Information

Your gift today will have a meaningful impact on the lives of people with Parkinson's disease and help provide the resources and research that will make a true difference.

Prefer to donate by check or phone?

Download and print the PDF Donation Form here. Mail or email your completed form to the address below, or call us at 800-233-2732 to make your donation over the phone.

American Parkinson Disease Association

P.O. Box 61420

Staten Island, NY 10306

E-mail: apda@apdaparkinson.org