Museum of Danish America · MODA Donation Form

Donation Amount *
$50
$100
$250
$500
$1,000
$2,500
$5,000

$

Donation Designation

*

Sponsorship Note

*

Please tell us which event or program you would like to sponsor.

Name Listing

*

Please let us know how you would like your name displayed for sponsorship recognition.

Immigrant Information Form

The Wall of Honor provides families and friends with a way to memorialize those who immigrated to America from Denmark. Please select the number of plaques you would like, fill out the Immigrant Information Form, save, and upload one form for each plaque below. To register names, please submit your contribution of $250 per name* with as much information as you can provide about your submission. Click here for more information about the Wall of Honor.

*Please note: Names must be limited to 40 characters, including spaces. No titles may be used. Married couples will share one plaque unless otherwise specified. For assistance or questions please contact Deb Christensen Larsen by telephone at 712.764.7001 or e-mail at development@danishmuseum.org.

Number of Submissions

*

Form #1

Form #2

Form #3

Form #4

Notes

If you are submitting more than one name please let us know if you would like them to be on one or two plaques.

Your Name

*

First Name

Last Name

Is this gift from an organization?

Yes

Organization Name

*

Your title

*

Email

*

Verify Email

*

Phone

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Spouse's Name

First Name

Last Name

Is this a tribute gift?

Tribute Information

Tribute Name

*

First Name

Last Name

Please notify:

First Name

Last Name

Email

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Dedication

Anonymous

I wish to keep my gift anonymous.

Subscribe

Please subscribe me to your mailing list. I understand that I can unsubscribe at any time

Yes