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Thank you for considering a donation to the American Telemedicine Association. ATA is a 501(c)3 organization and your donation is tax deductible.
Your contribution is greatly appreciated.
 This
is a secure site!
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To make a donation by check, print
and send this form to:
American Telemedicine Association
1100 Connecticut Avenue, NW Suite 540
Washington, DC 20036
Only credit card payments are accepted online.
(Visa, Mastercard, or American Express)
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| Sustaining
Contribution |
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Sustaining Membership
$500/year
Sustaining individual members will have their name listed on the ATA website and will be included in the ATA Member Update. |
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| Sustaining Corporate
Contribution |
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Sustaining Corporate Membership
$1,000 per year
Sustaining membership is in addition to the regular membership fees of $5,750 or $1725/year. Sustaining members will have their name listed on the ATA website and will be included in the ATA Member Update. |
| Contributions
to ATA |
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I would like
to make a contribution to ATA. All membership payments and contributions to ATA
are tax-deductible. |
| Total
Due:
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| Contributions to the
American Telemedicine Association, a tax-exempt organization under Section
501(c)(3) of the Internal Revenue Code, are deductible for computing income and
estate taxes. Contributors will be acknowledged on the ATA web site. |
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By submitting this application I agree to abide by and be subject to terms and
conditions of the Bylaws of the American Telemedicine Association
If you would like your donation to be made anonymously, please click here and tell us in a brief email. |
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