Mary's Place by the Sea · Mary's Place by the Sea Donation Form 2018

Donation

*

$400 - Host a woman for a day

$100

$50

$25

$

Donation Schedule (Single or Recurring)

Annual Appeal

Check here to direct your donation to our Annual Appeal

Annual Appeal 2018

Is this gift in Honor or Memory of someone?

*Please complete the questions following this one.

No

In Honor*

In Memory*

Please provide the name of person to be honored or memorialized

To whom should we notify regarding this tribute gift? Please provide the NAME and ADDRESS of the person(S) to be notified.

Donor/Contact Information

Billing information

Name

*

Prefix

First Name

Last Name

Suffix

Name (Secondary, if applicable)

Prefix

First Name

Last Name

Suffix

Organization/Employer (if applicable)

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Email

Phone

Special Note