YES, I want to help promote dental care for young children.

Donating is easy, just fill out the form below and press the submit button. You will be taken to a filled out form ready to be printed along with mailing instructions.

First Name
Last Name
St. Address 1
St. Address 2
City
State/Province
Zip/Postal Code
Country
Daytime Phone
Evening Phone
Email

I want to make a kid...

Beam: $100
Grin: $500
Smile: $1,000
Chuckle: $5,000
Giggle: $10,000
Chortle: $25,000
Guffaw: $50,000
Laugh Out Loud : $100,000
Roll With Laughter : $250,000
Other Amount (please fill in)

 

Your gift will help pay for equipment and expansion costs of the surgery center, prevention education, and future services for our region's neediest children.

If you have any questions, please email info@pedidental.org or contact Louis Ponick at 707-838-3058.

Our Tax ID number is 34-2012430. All contributions are tax deductible to the full extent of the law.

PRIVACY POLICY: PDI does not sell, trade, or otherwise disclose any information you provide.