Donations

In order to donate directly to The Jason Long Foundation, please fill out this form. Required fields are marked with an asterisk*.

First Name*:
Last Name*:
Address*:
City*:
State*:
Zip Code*:
Country:
Phone#:
Email*:
(we will hold all information confidential, and won't give it or sell it to anyone)
Note: If you would like to make a donation of $10,000 or more to the Foundation, or have a desire to provide some form of help or support, please email us at donations@jasonlongfoundation.com, and let us know of your intentions or desires. We will respond to you within 24 hours.
Donation Total:
(Input donation amount)
Recurring Donation:
(Check this box if you would like the above donation total to be donated every month)
Name on Credit Card*:
Credit Card*:
Credit Card#*:
Card Exp*:
Credit Card SID*:
Thank you for your support of The Jason Long Foundation, and the Huntsman Cancer Institute. Your donations are tax-deductible. Please check with a tax professional to verify your specific tax situation.