Test Donate Thank you for your gift! $ Donation Amount: Custom Amount Gift Designation Select Gift Account * Required Select Gift Account * Required Five4FERV Earl L. Smith Professorship Community Eyecare Services Community Eye Clinic Sam Quintero Endowment for Educational Excellence Optometry Student Scholarship Fund FERV Class Scholarships Jan Bergmanson Advanced Corneal Fellowship Endowment Mobile Eye Institute Gift of Your Choice (see below to specify) Giving to Class Scholarship or Named Endowment? Indicate year or name below. Specify 'Gift of your Choice' here. Recurring Monthly Donation? * Required Recurring Monthly Donation? * Required Yes No Select Payment Method Authorize.Net - Credit Card Personal Info First Name * Last Name Email Address * Credit Card Info This is a secure SSL encrypted payment. Card Number * CVC * Cardholder Name * Expiration * Billing Details Country * United StatesCanadaUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic People's RepublicCongo, Republic ofCook IslandsCosta RicaCote d'IvoireCroatia/HrvatskaCubaCyprus IslandCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEquatorial GuineaEl SalvadorEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGreeceGhanaGibraltarGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (City Vatican State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsEswatiniSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaTogoTokelauTongaThailandTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (USA)Wallis and Futuna IslandsWestern SaharaWestern SamoaYemenYugoslaviaZambiaZimbabwe Address 1 * Address 2 City * State * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaCanal ZoneCommonwealth of the Northern Mariana IslandsFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPhilippine IslandsPuerto RicoTrust Territory of the Pacific IslandsVirgin IslandsArmed Forces - AmericasArmed Forces - Europe, Canada, Middle East, AfricaArmed Forces - Pacific Zip / Postal Code * Donation Total: $100.00
