Please complete the following form and press the button labeled "Press Here to Continue". You will then be taken to a page with a summary confirmation and a button to complete payment at Paypal.com. Once there you will be able to either pay using a Paypal account or by credit/debit card. If you are paying by check, the mailing address for Edwards County EMS will be shown. In either case, Edwards County EMS will be informed of your gift.

Gift given in the name of


Please send a letter of acknowledgement to:

Name(s)*
Address*
Apt. or Suite
City*
State*
Zip*


Gift from:

Name*
Address*
Apt. or Suite
City*
State*
Zip*
Telephone*
Email Address*
Gift Amount* (Whole dollars only, no cents)
Payment Option
Special Instructions