Home This page may not work correctly in your current browser, Internet Explorer. We recommend changing to a more modern browser before viewing this page. We recommend Chrome, Firefox, Safari, or Edge. Team Vaccine Colorado Donation Thank you for donating to Immunize Colorado through our Team Vaccine Colorado program! Team Vaccine Colorado is a group of Immunize Colorado friends and supporters committed to donating a minimum of $250 each year to our coalition. Your donation directly impacts our efforts to expand our programs and services to better protect Colorado families and communities by actively supporting policies that increase vaccine uptake, growing community awareness of the safety and importance of immunization, providing high quality immunization-related education for health care providers, and strengthening our coalition. Please fill out the below form to complete your donation and join Team Vaccine Colorado. If you have any questions please contact Emily Clancy. Sincerely, The Immunize Colorado Team Suggested Donation Amounts: $25 I would like to give more. $250 I would like to give more. This is a one time donation Make this a recurring donation deducted Weekly Every 2 Weeks Monthly Every 2 Months Quarterly Every 6 Months Annually End Date: First Name: Last Name: Title: Credentials APRN BAN BSN CAN CCE CCM CDDN CIC CLC CMA CNA CNP CNS CPC CPNP CPT DNP DO DON EMT EPR FAAFP FNP FNP-C IBCLC IC LPN LST MA MD MMS MPAS MPH MS MSN MSPH MT(ASCP) NCSN ND NP NTM OH PA PA-C PharmD PhD PHN PHN II PNP PNP-C RMA RN RN-C RPh TNC Other Company: Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Zip Suffix Email: Phone: Tribute Name: List me as a donor: Yes No Acknowledge To: Comment: Credit this donation to a Fundraiser: Clancy TEST, Emily TEST Neon CRM by Neon One