Test NJUHC Donation Page Below here goes the CiviCRM donation forms. Donate to the New Jersey Universal Healthcare Coalition Test-drive Your Contribution Page This page is currently running in test-drive mode. Transactions will be sent to your payment processor's test server. No live financial transactions will be submitted. However, a contact record will be created or updated and a test contribution record will be saved to the database. Use obvious test contact names so you can review and delete these records as needed. Test contributions are not visible on the Contributions tab, but can be viewed by searching for 'Test Contributions' in the CiviContribute search form. Refer to your payment processor's documentation for information on values to use for test credit card number, security code, postal code, etc. By donating to the NJ Universal Healthcare Coalition, you will be helping tremendously in our efforts to advance Single Payer Health Plan legislation in NJ. Your contribution will go directly towards supporting the fight for quality healthcare for ALL NJ residents! To donate by check, fill out the information below and select "I will send payment by check" under Payment Options. A mailing address will be displayed when you click "Contribute." Donations made here support our political work, and are not tax-deductible. Contribution Amount $ 10.00 Annual Membership Dues (Individual) - $ 25.00 $ 50.00 Annual Membership Dues (Organization) - $ 100.00 Other Amount Other Amount $ Total Amount I want to contribute this amount every month I am contributing on behalf of an organization. On Behalf Of Organization Organization Name * Phone (Main) * Email (Main) * Street Address * City * Postal Code * Country * - select Country - United States Canada State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Honoree Information In Honor of In Memory of Select an option to reveal honoree information fields. Individual Prefix Mrs. Ms. Mr. Dr. Miss Mr. and Mrs. Professor Representative Rev. Sister Sen. Rep. Del. Com. Major (RET.) Senator First Name * Last Name * Honoree's Email Contact Information Email * First Name * Last Name * Street Address * Address Line 2 Country - select Country - United States Canada State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming City * Postal Code * Phone Payment Options [x] I will send payment by check Contribute username timestamp Footer text below the donation forms goes here.