Theriogenology Foundation

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Thank you for your generous donation to the Theriogenology Foundation. By submitting this form, you are providing us with your email address which will be added to our email list. You may unsubscribe at any time by choosing this option in the email.

Campaign/Fund Information
Campaign/Fund *	Research Grants or Select a Different Fund

Donation Information
Donation Amount *	OTHER: $
Payment Method *	Credit Card
Donation Type *	One-Time Donation Recurring Monthly Donation (until cancelled)
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Donor Information

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Billing Information
[ Click here if billing address is the same as donor address ]
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Exp. Date *	/
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The Cardholder stated above has authorized this payment. If this payment is part of a recurring series of payments, the Cardholder understands the terms and amounts of those recurring payments, and authorizes payment for each of them. Cardholder consent will expire once all scheduled recurring payments have been processed, or if all future recurrences are cancelled. The Cardholder acknowledges that specific payment dates may vary. Examples include, but are not limited to: payment dates falling during weekends, holidays, or during system outages. In order to facilitate the processing of those recurring payments, stored credentials will be used. Those stored credentials will only be used to process payments that are part of this series of recurrences. In order to use those stored credentials for any other payment, Cardholder re-authorization will be required. In the event that a consent agreement must be modified, the new agreement will be sent to the email address associated with the invoice.

The Cardholder understands the terms and authorizes the payment(s).

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14 Imperial Place, Unit 201
Providence, RI 02903
Phone: (334) 395-4666
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