Membership Checkout - My Green Doctor

Register Here as a Community Green Member

Membership Information

You have selected the Patron Green Member membership level.

Our Patron Green Members support our work with an annual donation of $100 to the My Green Doctor Foundation. Donations are tax deductible in the United

States. Thank you for supporting out work! Starting in 2025, Patrons are recognized in My Green Doctor’s Annual Report. Patrons have full access to My Green Doctor’s online resources. We welcome your inquiries and ideas. Please email Executive Director, Dr. Todd Sack: [email protected].

$100 THIS IS A TAX-DEDUCTIBLE CHARITABLE DONATION IN THE US.

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Account Information

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Email Address

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Office name

Type of office or medical practice

Number of employees (including doctors)

How did you hear about My Green Doctor?

Your healthcare organization membership, if any (choose one).

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Donation Amount

Please consider an additional tax-deductible contribution to the My Green Doctor Foundation, a 501(c)3 charitable foundation in the United States. Your donation of $100 will allow us to print 1250 educational brochures on sustainability and climate change for waiting rooms in practices in economically disadvantaged communities. Thank you.

More Information

Option Fields

Name of Office

Type of Medical Office

Number of Employees, Including Doctors

Mailing Address

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First Name

Last Name

Address 1

Address 2

City

State

Postal Code

Phone

Country

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