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

Donation

*

$400 - Host a woman for a day

$100

$50

$25

$

Donation Schedule (Single or Recurring)

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

Email communications

I would like to receive future email communications from Mary's Place by the Sea.

Yes, sign me up!

Phone

Special Note