nicaclinic.org Open in urlscan Pro
2606:4700:20::681a:125  Public Scan

Form analysis
4 forms found in the DOM

POST https://signup.oxfordclub.com/Content/SaveFreeSignups

<form id="LeadGen" method="post" action="https://signup.oxfordclub.com/Content/SaveFreeSignups" class="sign-up-form">
  <div style="text-align: center">
    <span id="form-label">Subscribe to our free e-letter!</span>
  </div>
  <input name="MultivariateId" type="hidden" value="1753846" style="display: none" id="mvId">
  <input name="NotSaveSignup" type="hidden" value="False" style="display: none">
  <div align="center" style="display: block">
    <div id="email-field-wrapper">
      <input type="email" name="email" size="40" maxlength="255" id="email" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" value="" placeholder="Your Email" aria-required="true" invalid="false"
        onfocus="javascript:if (this.value == '') this.value = '';" onblur="javascript:if (this.value == '') this.value = '';">
      <input type="tel" name="phone" id="phonenumber" style="display: none">
    </div>
    <input name="submit" type="submit" id="form-submit" value="Subscribe">
  </div>
</form>

POST https://signup.oxfordclub.com/Content/SaveFreeSignups

<form id="LeadGen" method="post" action="https://signup.oxfordclub.com/Content/SaveFreeSignups" class="sign-up-form">
  <div style="text-align: center">
    <span id="form-label">Subscribe to our free e-letter!</span>
  </div>
  <input name="MultivariateId" type="hidden" value="1753846" style="display: none" id="mvId">
  <input name="NotSaveSignup" type="hidden" value="False" style="display: none">
  <div align="center" style="display: block">
    <div id="email-field-wrapper">
      <input type="email" name="email" size="40" maxlength="255" id="email" class="wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email" value="" placeholder="Your Email" aria-required="true" invalid="false"
        onfocus="javascript:if (this.value == '') this.value = '';" onblur="javascript:if (this.value == '') this.value = '';">
      <input type="tel" name="phone" id="phonenumber" style="display: none">
    </div>
    <input name="submit" type="submit" id="form-submit" value="Subscribe">
  </div>
</form>

POST https://nicaclinic.org/?payment-mode=paypal

<form id="give-form-18285" class="give-form give-form-18285 give-form-type-multi" action="https://nicaclinic.org/?payment-mode=paypal" data-id="" data-currency_symbol="$" data-currency_code="USD" data-currency_position="before"
  data-thousands_separator="," data-decimal_separator="." data-number_decimals="2" method="post">
  <!--			                <input type="hidden" name="give-form-id" value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-form-title" value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-current-url"-->
  <!--			                       value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-form-url"-->
  <!--			                       value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-form-minimum"-->
  <!--			                       value="--><!--"/>-->
  <!-- The following field is for robots only, invisible to humans: -->
  <span class="give-hidden" style="display: none !important;">
    <label for="give-form-honeypot-18285"></label>
    <input id="give-form-honeypot-18285" type="text" name="give-honeypot" class="give-honeypot give-hidden">
  </span>
  <input type="hidden" name="give-price-id" value="0">
  <input type="hidden" name="give-form-id-prefix" value="">
  <input type="hidden" name="give-form-id" value="18285">
  <input type="hidden" name="give-form-title" value="Padrino Program Donations">
  <input type="hidden" name="give-current-url" value="https://nicaclinic.org/">
  <input type="hidden" name="give-form-url" value="https://nicaclinic.org/">
  <input type="hidden" name="give-form-minimum" value="1.00">
  <input type="hidden" name="give-form-maximum" value="999999.99">
  <input type="hidden" name="give-form-hash" value="577bb2bd2c" data-time="1732383912" data-nonce-life="86400" data-donor-session="0"><input type="hidden" name="give-price-id" value="0"> <input type="hidden" name="give-recurring-logged-in-only"
    class="give-recurring-logged-in-only" value="">
  <input type="hidden" name="give-logged-in-only" class="give-logged-in-only" value="1">
  <input type="hidden" name="give_recurring_donation_details" class="give_recurring_donation_details" id="give_recurring_donation_details" value="{&quot;is_recurring&quot;:false}">
  <div class="give-total-wrap">
    <div class="give-donation-amount form-row-wide">
      <span class="give-currency-symbol give-currency-position-before">$</span> <label class="give-hidden" for="give-amount">Donation Amount:</label>
      <input class="give-text-input give-amount-top" id="give-amount" name="give-amount" type="text" inputmode="decimal" placeholder="" value="250.00" autocomplete="off">
    </div>
  </div>
  <label for="give-donation-level-select-18285" class="give-hidden">Choose Your Donation Amount:</label><select id="give-donation-level-select-18285" class="give-select give-select-level give-donation-levels-wrap">
    <option data-price-id="0" class="give-donation-level-0 give-default-level" value="250.00" selected="selected" data-default="1">Become a Paisano - $250</option>
    <option data-price-id="1" class="give-donation-level-1" value="1,000.00" data-default="0">Become a Ranchero - $1000</option>
    <option data-price-id="2" class="give-donation-level-2" value="5,000.00" data-default="0">Become a Hacendado - $5000</option>
    <option data-price-id="custom" class="give-donation-level-custom" value="custom">Custom Donation</option>
  </select><input id="give-stripe-payment-method-0" type="hidden" name="give_stripe_payment_method" value="">
  <fieldset id="give-tributes-dedicate-donation-18285" class="give-tributes-dedicate-donation"> <!-- Give - Tributes Start -->
    <input type="hidden" class="give-tributes-type" name="give_tributes_type" value="In honor of">
    <legend>Dedicate this Donation</legend>
    <div id="give-tributes-options-18285">
      <ul id="give-tributes-show-wrap-18285" class="give-tributes-show-wrap">
        <li class="give-tributes-show-wrap-li">
          <input class="give-input" type="radio" id="give-tributes-yes-18285" name="give_tributes_show_dedication" value="yes">
          <label for="give-tributes-yes-18285" class="give-tributes-yes"> Yes, please</label>
        </li>
        <li class="give-tributes-show-wrap-li">
          <input class="give-input" type="radio" id="give-tributes-no-18285" name="give_tributes_show_dedication" checked="checked" value="no">
          <label for="give-tributes-no-18285" class="give-tributes-no"> No, thank you</label>
        </li>
      </ul>
    </div>
    <div id="give-tributes-type-wrap-18285" class="has_radios give_tributes_type_wrap" style="display: none;"> <!-- Give - Tributes type wrap start --><label class="give-tributes-label" for="give-tribute-type-18285"
        id="give-tribute-type-18285">Dedication Type</label>
      <ul id="give-tributes-type-radio-list-18285" class="give-tribute-radio-ul">
        <li><input type="radio" id="give-tributes-type-radio-in-honor-of-18285" name="give_tributes_radio_type" data-tribute-type="In honor of" class="give-tribute-type-radio" value="In honor of" checked="checked"><label
            for="give-tributes-type-radio-in-honor-of-18285" class="give-tributes-type-radio">In honor of</label></li>
        <li><input type="radio" id="give-tributes-type-radio-in-memory-of-18285" name="give_tributes_radio_type" data-tribute-type="In memory of" class="give-tribute-type-radio" value="In memory of"><label
            for="give-tributes-type-radio-in-memory-of-18285" class="give-tributes-type-radio">In memory of</label></li>
      </ul>
    </div> <!-- Give - Tributes type wrap end -->
    <div id="give-tributes-info-wrap-18285" class="give_tributes_info_wrap" style="display: none;"><!-- Give - Tributes Info Wrap Start -->
      <h3 class="give-section-break give-tributes-legend">Honoree Details</h3>
      <p id="give-tributes-first-name-wrap-18285" class="form-row form-row-first form-row-responsive">
        <label class="give-label" for="give-tributes-first-name-18285"> First Name <span class="give-required-indicator">*</span>
          <span class="give-tooltip hint--top" data-tooltip="The first name of the honoree." aria-label="The first name of the honoree."><i class="give-icon give-icon-question"></i></span>
        </label>
        <input class="give-input required" type="text" name="give_tributes_first_name" placeholder="Honoree First Name" id="give-tributes-first-name-18285" value="">
      </p>
      <p id="give-tributes-last-name-wrap-18285" class="form-row form-row-last form-row-responsive">
        <label class="give-label" for="give-tributes-last-name-18285"> Last Name <span class="give-tooltip hint--top" data-tooltip="The last name of the honoree."
            aria-label="The last name of the honoree."><i class="give-icon give-icon-question"></i></span>
        </label>
        <input class="give-input " type="text" name="give_tributes_last_name" placeholder="Honoree Last Name" id="give-tributes-last-name-18285" value="">
      </p>
    </div><!-- Give - Tributes Info Wrap End -->
    <div id="give-tributes-grab-info-wrap-18285" class="give_tributes_grab_info_wrap" style="display: none;"><!-- Give - Tributes Grab Info Start -->
      <label for="i-would-like-to" class="give-tribute-type give-tributes-label">Would you like us to notify anyone of your donation?</label>
      <ul id="give-tributes-grab-info-18285" class="give-tributes-grab-info">
        <li>
          <input class="give-input" id="give-tributes-send-an-ecard-18285" type="radio" name="give_tributes_would_to" value="send_eCard">
          <label for="give-tributes-send-an-ecard-18285" class="give-tributes-would-to"> Yes, send an eCard</label>
        </li>
        <li>
          <input class="give-input" id="give-tributes-none-18285" type="radio" name="give_tributes_would_to" checked="checked" value="none">
          <label for="give-tributes-none-18285" class="give-tributes-would-to"> No thanks</label>
        </li>
      </ul>
    </div><!-- Give - Tributes Info Wrap End -->
    <div class="give-tributes-notification-lists" id="give-tributes-notification-list-18285" style="display: none;"><!-- Give - Tributes eCard Notification list Start -->
      <div id="give-tributes-send-ecard-fields-18285" class="give_tributes_send_ecard_fields">
        <!-- Give - Tributes eCard Fields Start -->
        <h3 class="give-section-break give-tributes-legend"> Notification Details </h3>
        <input type="hidden" name="give_tributes_ecard_notify[recipient][personalized][]" value="">
        <div class="">
          <div id="give-tributes-ecard-notify-first-name-wrap-18285" class="form-row form-row-first form-row-responsive">
            <label class="give-label" for="give-tributes-ecard-notify-first-name-18285"> First Name <span class="give-required-indicator">*</span>
              <span class="give-tooltip hint--top" data-tooltip="The first name of the recipient." aria-label="The first name of the recipient."><i class="give-icon give-icon-question"></i></span>
            </label>
            <input class="give-input required" type="text" name="give_tributes_ecard_notify[recipient][first_name][]" placeholder="Recipient First Name" id="give-tributes-ecard-notify-first-name-18285" data-value="" value="">
          </div>
          <div id="give-tributes-ecard-notify-last-name-wrap-18285" class="form-row form-row-last form-row-responsive">
            <label class="give-label" for="give-tributes-ecard-notify-last-name-18285"> Last Name <span class="give-required-indicator">*</span>
              <span class="give-tooltip hint--top" data-tooltip="The last name of the recipient." aria-label="The last name of the recipient."><i class="give-icon give-icon-question"></i></span>
            </label>
            <input class="give-input required" type="text" name="give_tributes_ecard_notify[recipient][last_name][]" placeholder="Recipient Last Name" id="give-tributes-ecard-notify-last-name-18285" data-value="" value="">
          </div>
          <div id="give-tributes-ecard-email-18285" class="form-row form-row-wide form-row-responsive give_tributes_ecard_email">
            <label class="give-label" for="give-tributes-send-ecard-email-18285"> Email Address <span class="give-required-indicator">*</span>
              <span class="give-tooltip hint--top hint--medium" data-tooltip="This is the email address of the notification recipient."
                aria-label="This is the email address of the notification recipient."><i class="give-icon give-icon-question"></i></span>
            </label>
            <input class="give-input required" type="email" name="give_tributes_ecard_notify[recipient][email][]" placeholder="Recipient Email Address" id="give-tributes-send-ecard-email-18285" data-value="" value="">
          </div>
        </div>
      </div><!-- Give - Tributes eCard Fields End -->
    </div><!-- Give - Tributes eCard Notification list End -->
  </fieldset> <!-- Give - Tributes End -->
  <fieldset id="give-payment-mode-select" style="display: none;">
    <legend class="give-payment-mode-label">Select Payment Method <span class="give-loading-text" style="display: none;"><span class="give-loading-animation"></span>
      </span>
    </legend>
    <div id="give-payment-mode-wrap">
      <ul id="give-gateway-radio-list">
        <li class="give-gateway-option-selected">
          <input type="radio" name="payment-mode" class="give-gateway" id="give-gateway-paypal-" value="paypal" checked="checked">
          <label for="give-gateway-paypal-" class="give-gateway-option" id="give-gateway-option-paypal"> PayPal</label>
        </li>
      </ul>
    </div>
  </fieldset>
  <div id="give_purchase_form_wrap">
    <fieldset id="give_checkout_user_info" class="">
      <legend> Personal Info </legend>
      <p id="give-first-name-wrap" class="form-row form-row-first form-row-responsive">
        <label class="give-label" for="give-first"> First Name <span class="give-required-indicator">*</span>
          <span class="give-tooltip hint--top hint--medium hint--bounce" aria-label="First Name is used to personalize your donation record." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label>
        <input class="give-input required" type="text" name="give_first" autocomplete="given-name" placeholder="First Name" id="give-first" value="" required="" aria-required="true">
      </p>
      <p id="give-last-name-wrap" class="form-row form-row-last form-row-responsive">
        <label class="give-label" for="give-last"> Last Name <span class="give-tooltip hint--top hint--medium hint--bounce" aria-label="Last Name is used to personalize your donation record."
            rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label>
        <input class="give-input" type="text" name="give_last" autocomplete="family-name" id="give-last" placeholder="Last Name" value="">
      </p>
      <p id="give-email-wrap" class="form-row form-row-wide">
        <label class="give-label" for="give-email"> Email Address <span class="give-required-indicator">*</span>
          <span class="give-tooltip hint--top hint--medium hint--bounce" aria-label="We will send the donation receipt to this address." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label>
        <input class="give-input required" type="email" name="give_email" autocomplete="email" placeholder="Email Address" id="give-email" value="" required="" aria-required="true">
      </p>
    </fieldset>
    <div id="give-stripe-payment-errors-"></div>
    <fieldset id="give_purchase_submit" class="give-donation-submit">
      <p id="give-final-total-wrap" class="form-wrap ">
        <span class="give-donation-total-label"> Donation Total: </span>
        <span class="give-final-total-amount" data-total="250.00"> $250.00 </span>
      </p>
      <input type="hidden" name="give_action" value="purchase">
      <input type="hidden" name="give-gateway" value="paypal">
      <div class="give-submit-button-wrap give-clearfix">
        <input type="submit" class="give-submit give-btn" id="give-purchase-button" name="give-purchase" value="Donate" data-before-validation-label="Donate">
        <span class="give-loading-animation"></span>
      </div>
    </fieldset>
  </div>
</form>

POST https://nicaclinic.org/?payment-mode=paypal

<form id="give-form-17311" class="give-form give-form-17311 give-form-type-multi" action="https://nicaclinic.org/?payment-mode=paypal" data-id="" data-currency_symbol="$" data-currency_code="USD" data-currency_position="before"
  data-thousands_separator="," data-decimal_separator="." data-number_decimals="2" method="post">
  <!--			                <input type="hidden" name="give-form-id" value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-form-title" value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-current-url"-->
  <!--			                       value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-form-url"-->
  <!--			                       value="--><!--"/>-->
  <!--			                <input type="hidden" name="give-form-minimum"-->
  <!--			                       value="--><!--"/>-->
  <!-- The following field is for robots only, invisible to humans: -->
  <span class="give-hidden" style="display: none !important;">
    <label for="give-form-honeypot-17311"></label>
    <input id="give-form-honeypot-17311" type="text" name="give-honeypot" class="give-honeypot give-hidden">
  </span>
  <input type="hidden" name="give-price-id" value="1">
  <input type="hidden" name="give-form-id-prefix" value="">
  <input type="hidden" name="give-form-id" value="17311">
  <input type="hidden" name="give-form-title" value="Global Donation Form - NicaClinic">
  <input type="hidden" name="give-current-url" value="https://nicaclinic.org/">
  <input type="hidden" name="give-form-url" value="https://nicaclinic.org/">
  <input type="hidden" name="give-form-minimum" value="1.00">
  <input type="hidden" name="give-form-maximum" value="999999.99">
  <input type="hidden" name="give-form-hash" value="630a09417c" data-time="1732383912" data-nonce-life="86400" data-donor-session="0"><input type="hidden" name="give-price-id" value="1"> <input type="hidden" name="give-recurring-logged-in-only"
    class="give-recurring-logged-in-only" value="">
  <input type="hidden" name="give-logged-in-only" class="give-logged-in-only" value="1">
  <input type="hidden" name="give_recurring_donation_details" class="give_recurring_donation_details" id="give_recurring_donation_details" value="{&quot;is_recurring&quot;:false}">
  <div class="give-total-wrap">
    <div class="give-donation-amount form-row-wide">
      <span class="give-currency-symbol give-currency-position-before">$</span> <label class="give-hidden" for="give-amount">Donation Amount:</label>
      <input class="give-text-input give-amount-top" id="give-amount" name="give-amount" type="text" inputmode="decimal" placeholder="" value="50.00" autocomplete="off">
    </div>
  </div>
  <ul id="give-donation-level-button-wrap" class="give-donation-levels-wrap give-list-inline">
    <li><button type="button" data-price-id="0" class="give-donation-level-btn give-btn give-btn-level-0 " value="10.00" data-default="0">$10</button></li>
    <li><button type="button" data-price-id="1" class="give-donation-level-btn give-btn give-btn-level-1 give-default-level" value="50.00" data-default="1">$50</button></li>
    <li><button type="button" data-price-id="2" class="give-donation-level-btn give-btn give-btn-level-2 " value="100.00" data-default="0">$100</button></li>
    <li><button type="button" data-price-id="custom" class="give-donation-level-btn give-btn give-btn-level-custom" value="custom">Custom</button></li>
  </ul><input id="give-stripe-payment-method-0" type="hidden" name="give_stripe_payment_method" value="">
  <fieldset id="give-tributes-dedicate-donation-17311" class="give-tributes-dedicate-donation"> <!-- Give - Tributes Start -->
    <input type="hidden" class="give-tributes-type" name="give_tributes_type" value="In honor of">
    <legend>Dedicate this Donation</legend>
    <div id="give-tributes-options-17311">
      <ul id="give-tributes-show-wrap-17311" class="give-tributes-show-wrap">
        <li class="give-tributes-show-wrap-li">
          <input class="give-input" type="radio" id="give-tributes-yes-17311" name="give_tributes_show_dedication" value="yes">
          <label for="give-tributes-yes-17311" class="give-tributes-yes"> Yes, please</label>
        </li>
        <li class="give-tributes-show-wrap-li">
          <input class="give-input" type="radio" id="give-tributes-no-17311" name="give_tributes_show_dedication" checked="checked" value="no">
          <label for="give-tributes-no-17311" class="give-tributes-no"> No, thank you</label>
        </li>
      </ul>
    </div>
    <div id="give-tributes-type-wrap-17311" class="has_radios give_tributes_type_wrap" style="display: none;"> <!-- Give - Tributes type wrap start --><label class="give-tributes-label" for="give-tribute-type-17311"
        id="give-tribute-type-17311">Dedication Type</label>
      <ul id="give-tributes-type-radio-list-17311" class="give-tribute-radio-ul">
        <li><input type="radio" id="give-tributes-type-radio-in-honor-of-17311" name="give_tributes_radio_type" data-tribute-type="In honor of" class="give-tribute-type-radio" value="In honor of" checked="checked"><label
            for="give-tributes-type-radio-in-honor-of-17311" class="give-tributes-type-radio">In honor of</label></li>
        <li><input type="radio" id="give-tributes-type-radio-in-memory-of-17311" name="give_tributes_radio_type" data-tribute-type="In memory of" class="give-tribute-type-radio" value="In memory of"><label
            for="give-tributes-type-radio-in-memory-of-17311" class="give-tributes-type-radio">In memory of</label></li>
      </ul>
    </div> <!-- Give - Tributes type wrap end -->
    <div id="give-tributes-info-wrap-17311" class="give_tributes_info_wrap" style="display: none;"><!-- Give - Tributes Info Wrap Start -->
      <h3 class="give-section-break give-tributes-legend">Honoree Details</h3>
      <p id="give-tributes-first-name-wrap-17311" class="form-row form-row-first form-row-responsive">
        <label class="give-label" for="give-tributes-first-name-17311"> First Name <span class="give-required-indicator">*</span>
          <span class="give-tooltip hint--top" data-tooltip="The first name of the honoree." aria-label="The first name of the honoree."><i class="give-icon give-icon-question"></i></span>
        </label>
        <input class="give-input required" type="text" name="give_tributes_first_name" placeholder="Honoree First Name" id="give-tributes-first-name-17311" value="">
      </p>
      <p id="give-tributes-last-name-wrap-17311" class="form-row form-row-last form-row-responsive">
        <label class="give-label" for="give-tributes-last-name-17311"> Last Name <span class="give-tooltip hint--top" data-tooltip="The last name of the honoree."
            aria-label="The last name of the honoree."><i class="give-icon give-icon-question"></i></span>
        </label>
        <input class="give-input " type="text" name="give_tributes_last_name" placeholder="Honoree Last Name" id="give-tributes-last-name-17311" value="">
      </p>
    </div><!-- Give - Tributes Info Wrap End -->
    <div id="give-tributes-grab-info-wrap-17311" class="give_tributes_grab_info_wrap" style="display: none;"><!-- Give - Tributes Grab Info Start -->
      <label for="i-would-like-to" class="give-tribute-type give-tributes-label">Would you like us to notify anyone of your donation?</label>
      <ul id="give-tributes-grab-info-17311" class="give-tributes-grab-info">
        <li>
          <input class="give-input" id="give-tributes-send-an-ecard-17311" type="radio" name="give_tributes_would_to" value="send_eCard">
          <label for="give-tributes-send-an-ecard-17311" class="give-tributes-would-to"> Yes, send an eCard</label>
        </li>
        <li>
          <input class="give-input" id="give-tributes-none-17311" type="radio" name="give_tributes_would_to" checked="checked" value="none">
          <label for="give-tributes-none-17311" class="give-tributes-would-to"> No thanks</label>
        </li>
      </ul>
    </div><!-- Give - Tributes Info Wrap End -->
    <div class="give-tributes-notification-lists" id="give-tributes-notification-list-17311" style="display: none;"><!-- Give - Tributes eCard Notification list Start -->
      <div id="give-tributes-send-ecard-fields-17311" class="give_tributes_send_ecard_fields">
        <!-- Give - Tributes eCard Fields Start -->
        <h3 class="give-section-break give-tributes-legend"> Notification Details </h3>
        <input type="hidden" name="give_tributes_ecard_notify[recipient][personalized][]" value="">
        <div class="">
          <div id="give-tributes-ecard-notify-first-name-wrap-17311" class="form-row form-row-first form-row-responsive">
            <label class="give-label" for="give-tributes-ecard-notify-first-name-17311"> First Name <span class="give-required-indicator">*</span>
              <span class="give-tooltip hint--top" data-tooltip="The first name of the recipient." aria-label="The first name of the recipient."><i class="give-icon give-icon-question"></i></span>
            </label>
            <input class="give-input required" type="text" name="give_tributes_ecard_notify[recipient][first_name][]" placeholder="Recipient First Name" id="give-tributes-ecard-notify-first-name-17311" data-value="" value="">
          </div>
          <div id="give-tributes-ecard-notify-last-name-wrap-17311" class="form-row form-row-last form-row-responsive">
            <label class="give-label" for="give-tributes-ecard-notify-last-name-17311"> Last Name <span class="give-required-indicator">*</span>
              <span class="give-tooltip hint--top" data-tooltip="The last name of the recipient." aria-label="The last name of the recipient."><i class="give-icon give-icon-question"></i></span>
            </label>
            <input class="give-input required" type="text" name="give_tributes_ecard_notify[recipient][last_name][]" placeholder="Recipient Last Name" id="give-tributes-ecard-notify-last-name-17311" data-value="" value="">
          </div>
          <div id="give-tributes-ecard-email-17311" class="form-row form-row-wide form-row-responsive give_tributes_ecard_email">
            <label class="give-label" for="give-tributes-send-ecard-email-17311"> Email Address <span class="give-required-indicator">*</span>
              <span class="give-tooltip hint--top hint--medium" data-tooltip="This is the email address of the notification recipient."
                aria-label="This is the email address of the notification recipient."><i class="give-icon give-icon-question"></i></span>
            </label>
            <input class="give-input required" type="email" name="give_tributes_ecard_notify[recipient][email][]" placeholder="Recipient Email Address" id="give-tributes-send-ecard-email-17311" data-value="" value="">
          </div>
        </div>
      </div><!-- Give - Tributes eCard Fields End -->
    </div><!-- Give - Tributes eCard Notification list End -->
  </fieldset> <!-- Give - Tributes End -->
  <fieldset id="give-payment-mode-select" style="display: none;">
    <legend class="give-payment-mode-label">Select Payment Method <span class="give-loading-text" style="display: none;"><span class="give-loading-animation"></span>
      </span>
    </legend>
    <div id="give-payment-mode-wrap">
      <ul id="give-gateway-radio-list">
        <li class="give-gateway-option-selected">
          <input type="radio" name="payment-mode" class="give-gateway" id="give-gateway-paypal-" value="paypal" checked="checked">
          <label for="give-gateway-paypal-" class="give-gateway-option" id="give-gateway-option-paypal"> PayPal</label>
        </li>
      </ul>
    </div>
  </fieldset>
  <div id="give_purchase_form_wrap">
    <fieldset id="give_checkout_user_info" class="">
      <legend> Personal Info </legend>
      <p id="give-first-name-wrap" class="form-row form-row-first form-row-responsive">
        <label class="give-label" for="give-first"> First Name <span class="give-required-indicator">*</span>
          <span class="give-tooltip hint--top hint--medium hint--bounce" aria-label="First Name is used to personalize your donation record." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label>
        <input class="give-input required" type="text" name="give_first" autocomplete="given-name" placeholder="First Name" id="give-first" value="" required="" aria-required="true">
      </p>
      <p id="give-last-name-wrap" class="form-row form-row-last form-row-responsive">
        <label class="give-label" for="give-last"> Last Name <span class="give-tooltip hint--top hint--medium hint--bounce" aria-label="Last Name is used to personalize your donation record."
            rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label>
        <input class="give-input" type="text" name="give_last" autocomplete="family-name" id="give-last" placeholder="Last Name" value="">
      </p>
      <p id="give-email-wrap" class="form-row form-row-wide">
        <label class="give-label" for="give-email"> Email Address <span class="give-required-indicator">*</span>
          <span class="give-tooltip hint--top hint--medium hint--bounce" aria-label="We will send the donation receipt to this address." rel="tooltip"><i class="give-icon give-icon-question"></i></span> </label>
        <input class="give-input required" type="email" name="give_email" autocomplete="email" placeholder="Email Address" id="give-email" value="" required="" aria-required="true">
      </p>
    </fieldset>
    <div id="give-stripe-payment-errors-"></div>
    <fieldset id="give_purchase_submit" class="give-donation-submit">
      <p id="give-final-total-wrap" class="form-wrap ">
        <span class="give-donation-total-label"> Donation Total: </span>
        <span class="give-final-total-amount" data-total="50.00"> $50.00 </span>
      </p>
      <input type="hidden" name="give_action" value="purchase">
      <input type="hidden" name="give-gateway" value="paypal">
      <div class="give-submit-button-wrap give-clearfix">
        <input type="submit" class="give-submit give-btn" id="give-purchase-button" name="give-purchase" value="Donate" data-before-validation-label="Donate">
        <span class="give-loading-animation"></span>
      </div>
    </fieldset>
  </div>
</form>

Text Content

Our US Office
105 West Monument Street
Baltimore, Maryland
21201
Nicaragua
1 kilometro antes de Limon 1
Carratera Tola-Salinas,
Rivas
US: donorservices@nicaclinic.org
Nicaragua: 011-505-8887-7413
English Español Donate
 * Home
 * About Us
    * Mission
    * Clinic Team
    * Operational Reports
    * Join Our Team
    * About Dr. Gokhan Mamur
    * Our History
    * Financial Information
    * Our Top 10 Needs
    * Location
    * Testimonials

 * Programs
    * Volunteer Program
    * Volunteer Application
    * Clean Water Initiative
    * Healthy Eating Initiative
    * Donate For Salaries
    * Sponsor a Child
    * Expansion Project
    * Wellness Weekend 2024

 * Donations
    * Standard Donations
    * Crypto Donations

 * News
 * Videos
 * Contact Us

Donate
 * Home
 * About Us
    * Mission
    * Clinic Team
    * Operational Reports
    * Join Our Team
    * About Dr. Gokhan Mamur
    * Our History
    * Financial Information
    * Our Top 10 Needs
    * Location
    * Testimonials

 * Programs
    * Volunteer Program
    * Volunteer Application
    * Clean Water Initiative
    * Healthy Eating Initiative
    * Donate For Salaries
    * Sponsor a Child
    * Expansion Project
    * Wellness Weekend 2024

 * Donations
    * Standard Donations
    * Crypto Donations

 * News
 * Videos
 * Contact Us

Donate
Subscribe to our free e-letter!

EN ES Donate
Subscribe to our free e-letter!

 * Home

 * ABOUT US
   
   * Mission
   * Clinic Team
   * Operational Reports
   * Join Our Team
   * About Dr. Gokhan Mamur
   * Our History
   * Financial Information
   * Our Top 10 Needs
   * Location
   * Testimonials

 * PROGRAMS
   
   * Volunteer Program
   * Volunteer Application
   * Clean Water Initiative
   * Healthy Eating Initiative
   * Donate For Salaries
   * Sponsor a Child
   * Expansion Project
   * Wellness Weekend 2024
 * Donations
   * Standard Donations
   * Crypto Donations
 * News
 * Videos
 * Contact Us

12345678

Our team is on the ground helping with medical education and community support,
including clean water, emergency medicines and nutrition.

Please Donate Today


ESPECIALLY IN TIMES OF CRISIS – WE BELIEVE THAT EVERYONE DESERVES ACCESS TO
HEALTH CARE, CLEAN WATER AND PROPER NUTRITION.

You Can Help Here



SEND US A MESSAGE! WE WOULD LOVE TO HEAR FROM YOU. VOLUNTEERS AND SPECIFIC
DONATED SUPPLIES WELCOME.

Contact Us

Our Top 10 Needs


OUR 2022 IMPACT BY THE NUMBERS

View Now


ABOUT US



The Robert Clemente Health Clinic stands alone in this beautiful but
impoverished region. With the area’s only SUV emergency vehicle, the clinic
provides 24/7 free and affordable healthcare, supplies and innovative wellness
programs in the Southwest coastal communities of Nicaragua.





OUR MISSION



Our mission is to be an innovative and reliable provider of the full spectrum of
high-quality primary care, pediatric care, urgent care and holistic wellness
education and service – and to make these services and supplies affordable or
free for many Nicaraguan communities.




OUR TEAM



In Nicaragua, our local team consists of doctors, nurses, program directors,
administrators, maintenance workers, consultants and local advisors. You can
volunteer overseas in Nicaragua and gain a great experience.




OUR BOARD OF DIRECTORS



Our team is composed of the board of program directors; a medically trained
executive director in the U.S. who oversees all aspects of our organization; and
our advisory board, which helps the executive director with technical issues and
provides support for the fundraising activities.






VOLUNTEER ABROAD NICARAGUA



The volunteer program at The Roberto Clemente Health Clinic is as rewarding to
the volunteers as it is to the local patients. We invite anyone with interest in
an international volunteer experience.


Read more Donate


DONATIONS



Help us continue our work by supporting our projects with donations




PADRINO PROGRAM DONATIONS


Donate


INDIVIDUAL DONATION


Donate


SPONSOR A CHILD – RECURRING


Donate
View more


DONATIONS



Help us continue our work by supporting our projects with donations


Donate


BECOME A HACENDADO

With a magnanimous donation of $5,000 or more, we would like to place your name
on a plaque at the Clinic. We will also send you a voucher for two free nights
accommodations at the nearby, gorgeous Rancho Santana resort on the Pacific
coast as our thank you.

Donate


BECOME A RANCHERO

With a donation of $1,000 or more, we will send you a Clinic T-shirt as our
thank you.

Donate


BECOME A PAISANO

With a donation of $250 or more, you will help us afford all the items on the
community and Clinic’s wish list. We greatly appreciate your time and
thoughtfulness.

View more


LATEST NEWS




 * A CRITICAL MESSAGE FROM OUR CEO
   
   by Julia Guth
   Newsletter
   November 15, 2024
   
   Our new Clinic CEO, Dr. Shawn Borich, M.D. MPH recently returned from
   visiting our Clinic team in Nicaragua. ...
   
   Read more


 * A NEW VISION FOR OUR NICACLINIC
   
   by Julia Guth
   News, Newsletter
   July 12, 2024
   
   Dear friend of the Clinic, In early June, our new CEO Dr. Shawn
   Borich traveled to the Clinic with former ...
   
   Read more


 * THIS FATHER’S BIGGEST WISH
   
   by Julia Guth
   News, Newsletter
   June 21, 2024
   
   We Have a Matching Fund Donor: Help Grant this Father’s Biggest Wish – and
   Double Your Impact! Goo...
   
   Read more




OUR PROGRAMS

Please support our current and future programs




HELP US CONTINUE OUR WORK BY SUPPORTING OUR PROJECTS

Read More
 * 
 * 
 * 

ABOUT US

The Roberto Clemente Health Clinic stands alone in this beautiful but
impoverished region. With the area’s only SUV emergency vehicle, the clinic
provides 24/7 free and affordable healthcare, supplies and innovative wellness
programs in the Southwest coastal communities of Nicaragua.

Great news! We are thrilled to announce that the Clinic received the prestigious
2022 Top-Rated Nonprofit Award given by GreatNonprofits, the leading provider of
user reviews about nonprofit organizations.

    



LINKS

 * Top 10 Needs
 * Join Our Team
 * Operational Reports
 * Volunteer Application
 * Donations
 * FAQ
 * Do Not Sell My Info

CONTACT US

OUR US OFFICE

105 West Monument Street
Baltimore, Maryland
21201

EMAIL US DONORSERVICES@NICACLINIC.ORG 



NICARAGUA

1 kilometro antes de Limon 1 Carratera
Tola-Salinas, Rivas

CALL US 011-505-8887-7413

FOLLOW US / SHARE



The Roberto Clemente – Santa Ana Health Clinic

$ Donation Amount:
Choose Your Donation Amount:Become a Paisano - $250Become a Ranchero -
$1000Become a Hacendado - $5000Custom Donation Dedicate this Donation
 * Yes, please
 * No, thank you

Dedication Type
 * In honor of
 * In memory of


HONOREE DETAILS

First Name *

Last Name

Would you like us to notify anyone of your donation?
 * Yes, send an eCard
 * No thanks


NOTIFICATION DETAILS

First Name *
Last Name *
Email Address *
Select Payment Method
 * PayPal

Personal Info

First Name *

Last Name

Email Address *



Donation Total: $250.00


$ Donation Amount:
 * $10
 * $50
 * $100
 * Custom

Dedicate this Donation
 * Yes, please
 * No, thank you

Dedication Type
 * In honor of
 * In memory of


HONOREE DETAILS

First Name *

Last Name

Would you like us to notify anyone of your donation?
 * Yes, send an eCard
 * No thanks


NOTIFICATION DETAILS

First Name *
Last Name *
Email Address *
Select Payment Method
 * PayPal

Personal Info

First Name *

Last Name

Email Address *



Donation Total: $50.00




Notifications