Thank you for supporting the Epilepsy Foundation of San Diego County

Your gift will help us to provide free programs and services to the more than 50,000 people in San Diego County affected by epilepsy. Your donation stays here in San Diego and is 100% tax deductible. Tax ID# 95-1981182
* required information
Donation Form
Donation Amount
:* $


Donor Information
First Name:
Middle Initial:
Last Name:*
Company Name:
Address Line 1:
Address Line 2:
City:
State:
ZIP/Postal Code:
Phone:
Email:
Memorial/Honorary Gift: In Memory Of
In Honor Of
Honoree Name:
Gift Note:
Payment Information
Payment Method
:*
:*
Credit Card Type:*
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
:*
:
:*
State:
:
:*
Country:*
Matching Gift Information
Many workplaces offer a partial or full matching gift option.
Will this donation be potentially matched?
If you know the following information regarding the matching gift, please complete.
Company Name:
Matching Gift Amount:$
By clicking Submit,
your credit card will be processed