Donate

Thank you for your interest in supporting RxAid.org! Your contribution helps us provide life-saving medications to those who need them most. Please fill out the form below to join our community of supporters.

Personal Information

First Name

Last Name

Date of Birth

Phone Number

Mailing Address

Street Address

City

State/Province

ZIP/Postal Code

Country

Donation options

I Would Like to Support RxAid.org By

Donation options

Donating surplus medications Making a financial contribution Volunteering my time or skills Raising awareness through social media or my community Partnering my business/organization with RxAid.org

other donation option

Confirmation

If Donating Medications, Please Confirm:

Donation confirmation

I understand that all medications must be unexpired, unopened, and in their original packaging. I would like to receive a prepaid envelope for medication donation.

If Making a Financial Contribution, Please Select:

i confirm that

One-Time Donation Monthly Donation Annual Donation

(You will be redirected to our secure payment portal after submitting this form.)

Are You Interested in Volunteering?

Are You Interested in Volunteering?

Yes, I’m available to volunteer remotely. Not at this time, but keep me informed of future opportunities. Yes, I’m available to volunteer locally (please specify location):

Volunteering Location

Additional Comments/Questions

Additional Comments/Questions

By submitting this application, I consent to RxAid.org reviewing my personal and health information to determine eligibility for the program.

By submitting this form, I agree to receive communications from RxAid.org about opportunities to support its mission.

Quick Links

Home
Donate
Apply
Testimonials
Blog
Contact Us

Home
Donate
Apply
Testimonials
Blog
Contact Us

Contact Details

(123) 456 7890
info@rxaid.com
California USA

Instagram Linkedin-in Facebook-f Pinterest Tiktok

Privacy Policy
Terms & Conditions

Scroll to Top

Donate

Donate

Quick Links

Contact Details

Follow Us

Copyright 2024 © RxAid. All Rights Reserved.