AOS Donations


Donation by check should be sent to:

American Optometric Society
c/o Dr. Tom Cheezum
801 Volvo Parkway, Suite #133
Chesapeake, VA 23320


 

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First Name:  *  
Last Name:  *  
Address:  *  
Address 2:
City:  *  
State:  *  
Zip Code:  *  
Email:  *  
Confirm Email:  *  

Amount ($):  *  
$200.00       
$350.00       
$500.00       
$1000.00       
   [You may insert your donation amount here instead of using one of the above amounts.]
Payment Frequency:  *  
Start Date:  *   calendar
No. of Donations:  *  

ADDITIONAL INFORMATION
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Comments:

PAYMENT INFORMATION
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Credit Card Type:  *  

Credit Card Number:  *  
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Expiration Date:  *     (mm/yy)
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