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Amount
*
$2,500
$1,000
$250
$100
$50
$25
$
Donation Schedule
One Time
Monthly
Donor's Contact Information
This gift to MiCAN is made on behalf of:
A Business or Organization
An Individual or Family
Organization or Business Name
*
Contact's Name
*
First Name
Last Name
Contact's Email Address
*
Your tax receipt, thank you messages and updates will be sent to this address.
Verify Email
*
Contact's Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Contact's Cell Phone
This number will be used for immediate need, calls to action.
Would you like to be listed as an anonymous donor?
*
Yes, please DO NOT publish my name as a donor.
No, please feel free to include my name as a donor.
I would like my entire gift amount to support MiCAN, so please add 3% to my total to help cover the payment processing fees.