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nicaclinic.org Open in urlscan Pro
2606:4700:20::ac43:4838  Public Scan

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Submitted URL: https://events-c.mb.wealthyretirement.com/z/sc0ktbb80jtr04?uid=7385b1cd-b78e-4ddb-9f53-a22cb8ce0718&txnid=c798e55b-7f34-4a92-803a-5c2ec03f...
Effective URL: https://nicaclinic.org/individual-donations/?bsft_aaid=782fb40b-7585-4cb2-b342-5e6bb6114589&bsft_eid=e0eadc63-7c06-4481...
Submission: On November 23 via api from BE — Scanned from DE

Form analysis 6 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://www.paypal.com/cgi-bin/webscr

<form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_top"><input name="cmd" type="hidden" value="_donations"><input name="business" type="hidden" value="customerservice@nicaclinic.org"><input name="currency_code" type="hidden"
    value="USD"><button class="edgtf-btn edgtf-btn-small edgtf-btn-solid edgtf-btn-custom-hover-bg edgtf-btn-custom-border-hover edgtf-btn-custom-hover-color btn-donate-global"
    style="color: #ffffff; background-color: #e0a128; border-color: #e0a128; font-size: 24px; font-weight: bold; width: 50%;" title="PayPal - The safer, easier way to pay online!" name="submit" type="image">Donate</button><img decoding="async"
    src="https://www.paypal.com/en_US/i/scr/pixel.gif" alt="" width="1" height="1" border="0"></form>

POST https://www.paypal.com/cgi-bin/webscr

<form action="https://www.paypal.com/cgi-bin/webscr" method="post" target="_top"><input name="cmd" type="hidden" value="_donations"><input name="business" type="hidden" value="customerservice@nicaclinic.org"><input name="currency_code" type="hidden"
    value="USD"><button class="edgtf-btn edgtf-btn-small edgtf-btn-solid edgtf-btn-custom-hover-bg edgtf-btn-custom-border-hover edgtf-btn-custom-hover-color btn-donate-global"
    style="color: #ffffff; background-color: #e0a128; border-color: #e0a128; font-size: 24px; font-weight: bold; width: 50%;" title="PayPal - The safer, easier way to pay online!" name="submit" type="image">Donate</button><img decoding="async"
    src="https://www.paypal.com/en_US/i/scr/pixel.gif" alt="" width="1" height="1" border="0"></form>

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

<form id="give-form-18285" class="give-form give-form-18285 give-form-type-multi" action="https://nicaclinic.org/individual-donations/?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/individual-donations/">
  <input type="hidden" name="give-form-url" value="https://nicaclinic.org/individual-donations/">
  <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="1732383889" 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>
    </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/individual-donations/?payment-mode=paypal

<form id="give-form-17311" class="give-form give-form-17311 give-form-type-multi" action="https://nicaclinic.org/individual-donations/?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/individual-donations/">
  <input type="hidden" name="give-form-url" value="https://nicaclinic.org/individual-donations/">
  <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="1732383889" 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


SUPPORT OUR CLINIC

Make a Donation Today!


JOIN THE PADRINO PROGRAM TODAY



Make a big difference in the well-being of a child and family with your monthly
donation.
Only $25/month provides health checks, medicine & nutritional support at Clinic,
Only $50/month provides for health services above –plus education supplies,
backpack and uniforms for school.

Sponsor a Child Monthly
Donate


We could really use your help…

We need more resources and funds to add staff, get more medicines, replace
equipment, repair and upgrade our facility and vehicles, and distribute donated
supplies.

The Clinic is a 24/7 operation and it treats tens of thousands of patients each
year. No donation is too small.

Here’s how contributions of any size can help…

Resource Monthly Donation One “first year” doctor $835 Provide clean water for
school and health centers for one month $250 Provide food for 50 families for
one month $175 Fund one community healthcare outreach event $100 Support one
Padrino child for one year $50 Support one community organic farm plot for one
month $10

Please join us in this life-saving work.

Your tax-deductible gift to The Roberto Clemente Health Clinic, a 501(c)(3)
non-profit, will help deliver clean water, health services and urgent care, and
greater empowerment to the most vulnerable in Nicaragua.

*We can accept stock and Bitcoin donations as well. Click here for additional
information. You can also email us at donorservices@nicaclinic.org with
additional questions.


DONATIONS ARE


100% SECURE AND TAX DEDUCTIBLE

|



Donate




INDIVIDUAL DONATIONS



If You would like to make a Recurring or One-Time Contribution, select the level
you would like to join.




BECOME A HACENDADO

Donate


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.




BECOME A RANCHERO

Donate


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




BECOME A PAISANO

Donate


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.




BECOME A AMIGO

Donate


Feel free to select the amount that you want to donate and make it a recurrent
monthly donation if you want and join the Padrino Sponsor a Child Program.





SUCCESSFUL INITIATIVES AND PROGRAMS



Help us continue our work by supporting our projects


Read More


THE VOLUNTEER PROGRAM


Read More


A GIFT FOR FRIENDS OR FAMILY


Read More


SPONSOR A CHILD


Read More


CLEAN WATER INITIATIVE


Read More


EXPANSION PROJECT


Read More


HOST AN EVENT


Read More


ESTATE GIVING


Read More


CORPORATE SPONSORSHIP


Read More


HEALTHY EATING INITIATIVE


Read More


BUY T-SHIRT




INDIVIDUAL DONATION (LOU BASENESE)


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


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