LifeBridge Community Services

Donation Amount:

*

$

Would you like to make a monthly gift? Use the drop-down below.

Continue donating until

(mm/dd/yyyy)

Where would you like to direct your gift?

*

Please provide additional details on how you would like to direct your gift.

*

Your Contact Information

I'm making this donation as an:

*

Individual

Organization

Organization/Employer

*

Name

*

First Name

Last Name

Include a spouse/partner as a joint donor for this donation?

*

If yes, your spouse will be included on tax receipts and acknowledgments for this gift.

Yes

No

Spouse's Name

First Name

Last Name

Is this gift anonymous?

*

Yes

No

If we have your permission to publicly acknowledge this contribution, how you would like your name(s) printed?

Email

*

Verify Email

*

Phone

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

In Honor/In Memory Gifts

Is this gift in memory or in honor of someone?

*

No

In Memory of

In Honor of

Name for In Memory or In Honor of Gifts

Dedication

Should we notify anyone of this donation?

*

Select "yes" if you would like us to notify the individual (in honor of) or the family (in memory of) for this donation.

Yes, please email the honoree

Yes, please mail the honoree

Yes, please email the deceased's family/friend

Yes, please mail the deceased's family/friend

No

Who to Notify for In Honor/In Memory of Gift:

First Name

Last Name

Notification Email for In Honor/In Memory of Gift:

Verify Email

Notification Address for In Honor/In Memory of Gift

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Payment Information

We are charged a small fee by payment processors to accept online payments. If you would like to help offset these fees, please check the "Add 3% to my total..." checkbox. We greatly appreciate your generosity!