Your financial and in-kind support directly impacts our patients’ lives through accessible health care. Donation Form Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Donation Amount* $50 Supporter; $100 Friend; $250 Steward; $500 Patron; $2008 Founder's SocietyOptions I/We would like to donate stocks – please contact me. Please contact me about my employer’s matching fund. I/We would like to remain Anonymous. Please contact me about my estate plans for MFHC. I would like to Donate to honor someone: I would like to Donate in memory of someone: Donation in honor of:Donation in memory of:Moab Free Health Clinic is a 501(c)3 not-for-profit organization. Monetary and in-kind donations are tax-deductible. Donations in exchange for patient services and goods are not tax-deductible.Total $0.00 CAPTCHACommentsThis field is for validation purposes and should be left unchanged.