Please enter your name and billing address as they appear on your credit card statement.
First Name *
Middle Name
Last Name *
Company Name
Address 1 *
Address 2
City *
U.S. State *
(if outside the U.S. please select 'Other')
Postal Code *
Please enter your payment information
Card Number *
CSC Number * What's this?
Expiration Date *
Please select the donation amount *

Please enter your contact information.
Daytime Phone * (Example: 123-456-7890)
Evening Phone (Example: 123-456-7890)
Email Address * (Example:
Send me MDA eNews
I would like my Gift to support the following:
I want to know more about sustaining donations.
Save this information so that I won't have to re-enter this information in the future and can quickly make donations and view my history using QuickClick.
This is required for sustaining donations. Your username is your email address you have given above. Please enter a password.
Passwords must be at least six characters in length.
Enter Password
Confirm Password
Muscular Dystrophy Association
National Headquarters
3300 East Sunrise Drive
Tucson, AZ 85718