Texas Public Health Association

Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund *	Gift of Membership or Select a Different Fund

Donation Information
Donation Amount *	Student: $30.00 Emerging Professional: $40.00 Active/Associate: $75.00 Retired Active/Associate: $50.00
Payment Method *	PayPal Credit Card
Gift Recipient Name and Email Address *	Please provide the name and email address of the gift recipient so that we may notify them of your gift.
Donor Comments

Donor Information

First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State	(Reset)
Postal Code*
Phone *

Billing Information
[ Click here if billing address is the same as donor address ]
Name on Card *
Card Type *
Card Number *
Card CVV Num *	What is this?
Exp. Date *	/
Organization
Address *
Address Cont.
City/Town *
Country *
State	(Reset)
Postal Code*
Billing Phone *

The Cardholder stated above has authorized this payment. If this payment is part of a recurring series of payments, the Cardholder understands the terms and amounts of those recurring payments, and authorizes payment for each of them. Cardholder consent will expire once all scheduled recurring payments have been processed, or if all future recurrences are cancelled. The Cardholder acknowledges that specific payment dates may vary. Examples include, but are not limited to: payment dates falling during weekends, holidays, or during system outages. In order to facilitate the processing of those recurring payments, stored credentials will be used. Those stored credentials will only be used to process payments that are part of this series of recurrences. In order to use those stored credentials for any other payment, Cardholder re-authorization will be required. In the event that a consent agreement must be modified, the new agreement will be sent to the email address associated with the invoice.

The Cardholder understands the terms and authorizes the payment(s).

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Calendar more

3/25/2026
2026 AEC Program Planning Committee Meeting

4/15/2026
2026 AEC Program Planning Committee Meeting

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Texas Public Health Association PO Box 9610 Longview, Texas 75608

Texas Public Health Association
PO Box 9610
Longview, Texas 75608