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Donation Form
Donor Information
Amount
*
$25
$50
$75
$100
$150
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Donor Name(s)
*
First Name
Last Name
Organization/Company Donor Name
Donor Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Donor Email
*
Verify Email
*
Donor Phone
*
Donation Information
This donation is:
*
A general donation
In honor of someone
In memory of someone
In Honor/Memory Of
*
First Name
Last Name
Notify honoree/family of deceased about my donation
*
Yes
No
Recipient Notification Information
Send Notification To
*
First Name
Last Name
Mailing address of person to be notified
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Email of person to be notified
Verify Email
Name
First Name
Last Name
Add 3% to my total amount to help cover the payment processing fees