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Mountain Home Donation Form
Amount
*
$1,000
$250
$100
$50
$35
$
Donation Schedule
One Time
Monthly
Quarterly
Annually
Contact Information
Name
*
First Name
Last Name
Spouse/Partner Name
optional
Organization
optional (for company/group giving)
Email
*
Phone
Address
*
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Is this a tribute gift?
*
No
Yes, In Honor of
Yes, In Memory of
Dedication Name
First Name
Last Name
Address of honoree (acknowledgement card will be sent):
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Your dedication message to the honoree:
Gift in memory of:
Name of family or friend to be notified:
Address of family member or friend to be notified:
Your dedication message to the recipient:
I prefer that this donation remains anonymous to the public:
select one
No
Yes
Add 3% to my total amount to help cover the payment processing fees