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Creston Clinic Giving Form

Please fill out the form below. Required fields are marked with asterisks (*).

Thank you for choosing to give to The Friends of Creston Children's Dental Clinic. Your donation is 100% tax-deductible.

 
 

Contact Information

Title:

First Name: *

Last Name: *

Degree/Certification:

Address:

City:

State:

ZIP:

Home Phone:

Other Phone:

Email Address: *

 

Please keep me informed about Creston Dental Clinic news and events.

 

I would like to purchase a ticket(s) to the annual luncheon 2017.

 

I would like to sponsor the annual luncheon 2017.

 

I am interested in being contacted by the Creston Dental administrator to learn more.

 

I am a dental professional and would like to help with Creston Dental.

 

Please contact me about making a contribution to the Creston Dental.

 

How would you prefer to be contacted?

Phone Email

 

Donation Information

The Creston Dental relies on the financial support of individuals and organizations to continue to provide assistance for the critical dental needs of uninsured children K-12 in the Portland public school system. If you would like to support Creston with a 100% tax-deductible contribution, please fill out the fields below.

 

I would like to make my donation by:

Check
Credit Card
Other

The amount of my donation is: $

 
 
 

For checks sent by mail:
Make check to: Friends of Creston Children's Dental Clinic
P.O. Box 86368
Portland, Oregon 97286

I would like to receive a self addressed envelope to send in my check.

 

For other contributions, please describe:

 

Donate by Credit Card

If you would like to make your contribution to Creston Dental by credit card, please enter your credit card information below.

Credit Card Number:

Name on Card:

Expiration Date (mm/yyyy):

CVV Number (on back of card):

 

Thank you for your support. If you are making a donation to Creston Dental with this submission, you will receive a confirmation email and a receipt for your contribution.

 
 
 

It may take a moment to submit your information. Please wait for a confirmation message.

Mailing Address

P.O. Box 86368
Portland, Oregon 97286

Clinic Address

4701 SE Bush St.,
Portland, OR 97206


Mailing Address

P.O. Box 86368
Portland, Oregon 97286

Clinic Address

4701 SE Bush St.,
Portland, OR 97206




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