Life Pediatric Clinic

Life Pediatric Ministries is a medical clinic that serves economically under-privileged children in Santiago, Dominican Republic.

Gift Amount

Please select a gift amount below, or enter your own amount by clicking "Other".

Giving Frequency

Would you like to donate anonymously?

Enter Your Information

Account Type

First Name *

Last Name *

Suffix

Organization Name

Organization Type

Title (Primary Contact )

First Name (Primary Contact )

Last Name (Primary Contact )

Suffix (Primary Contact )

Email Address *

Billing Address

Country *

Address Line 1 *

Address Line 2

City *

State *

Postal Code *

Create an Account

(optional)

Adding a password will create an account and allow you to access your transaction history as well as manage account details. This is an optional step and can be completed at a later date if desired.

Password Requirements
* length of 8+ characters
* at least one special character (!,@,#,$,%,&,*, etc)
* at least one digit (0-9)
* at least one uppercase (A-Z)

Password

Confirm Password

Payment Information

Would you like to cover the 3% Processing Fees?

Routing Number

Account Number

Checking

Savings

Card Number

Expiration Date

Verification Number

Save this payment for later use.