Adopt-A-Village – AAPI Rural Health Initiative in India – American Association of Physicians of Indian Origin

First Name

Middle Name

Last Name

Address

City

State/Province

Zip/Postal

Country

Product

Adopt a Village (AAPI): $2,500.00

Quantity

Total

Paying By

Credit Card

Check

Cardholder Name

Credit Card

Card Number

Credit Card

Year

CVC

Month

Please mail a check to
American Association of Physicians of Indian Origin
600 Enterprise Drive, Suite 108
Oak Brook, IL 60523

Memo: AAPI-Adopt-A-Village in India

Adopt-A-Village – AAPI Rural Health Initiative in India