Online Donation

Use the form below to make payments to AEMS electronically.
View Payment Options at the bottom of form.

Donor information

Campaign

Fire Department/District - Serving Population of 300k +

First Name*

Last Name*

Organization*

Address*

Address 2

City*

State*

Zip*

Country*

Phone*

Email*

Comment

Donation Information

Amount

$ 1,500.00 [ Annual Dues - One Year ] $ 2,800.00 [ Annual Dues - Two Year ]

Payment method *

Paypal
Offline Payment

Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card type*

Card Holder Name*

$ 1,500.00 [ Annual Dues - One Year ] $ 2,800.00 [ Annual Dues - Two Year ]

$ 500.00 [ Annual Dues One Year ] $ 950.00 [ Annual Dues Two Year ]

$ 750.00 [ Annual Dues - One Year ] $ 1,400.00 [ Annual Dues - Two Year ]

$ 1,500.00 [ Annual Dues - One Year ] $ 2,800.00 [ Annual Dues - Two Year ]

$ 1,000.00 [ Annual Dues - One Year - for those Fire Departments/Districts that Do Not Provide Ground Ambulance Transport ] $ 1,900.00 [ Annual Dues - Two Year - for those Fire Departments/Districts that Do Not Provide Ground Ambulance Transport ] $ 1,250.00 [ Annual Dues - One Year - for those Fire Departments/Districts that Provide Ground Ambulance Transport ] $ 2,350.00 [ Annual Dues - Two Year - for those Fire Departments/Districts that Provide Ground Ambulance Transport ]

$ 500.00 [ Annual Dues - One Year - for those Fire Departments/Districts that Do Not Provide Ground Ambulance Transport ] $ 950.00 [ Annual Dues - Two Year - for those Fire Departments/Districts that Do Not Provide Ground Ambulance Transport ] $ 750.00 [ Annual Dues - One Year - for those Fire Departments/Districts that Provide Ground Ambulance Transport ] $ 1,200.00 [ Annual Dues - Two Year - for those Fire Departments/Districts that Provide Ground Ambulance Transport ]

$ 250.00 [ Annual Dues - One Year - for those Fire Department/Districts that Do Not Provide Ground Ambulance Transport ] $ 450.00 [ Annual Dues - Two Year - for those Fire Department/Districts that Do Not Provide Ground Ambulance Transport ] $ 500.00 [ Annual Dues - One Year - for those Fire Department/Districts that Provide Ground Ambulance Transport ] $ 700.00 [ Annual Dues - Two Year - for those Fire Department/Districts that Provide Ground Ambulance Transport ]

$ 1,500.00 [ Annual Dues - One Year ] $ 2,800.00 [ Annual Dues - Two Year ]

$ 500.00 [ Annual Dues - One Year ] $ 950.00 [ Annual Dues - Two Year ]

$ 300.00 [ Annual Dues - One Year ] $ 550.00 [ Annual Dues - Two Year ]

$ 500.00 [ Annual Dues - One Year ] $ 950.00 [ Annual Dues - Two Year ]

$ 250.00 [ Annual Dues - One Year ] $ 450.00 [ Annual Dues - Two Year ]

$ 25.00 $ 50.00 $ 100.00 $ 250.00 $ 500.00 $ 1,000.00 $ 2,500.00 $ 5,000.00

Fire Department/District - 300k to

Online Donation

Donor information

Donation Information

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