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Donation Form
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Anonymous Donation?
Select "YES" if you would prefer NOT to be listed by name in our public donor reports on the website and in Focus.
YES, I want my donation to be anonymous
No
PLEASE CONFIRM that you want the donation to be anonymous:
YES, I want my donation to be anonymous
I want my name listed for this donation
Donation Information
We are grateful for any amount you can give.
Donation Amount
$100
$50
$25
$
Fund Designation
You can specify a fund for your donation or leave it in our General Fund to be used as needed.
select one
General Fund
Rescue
Health Studies (general)
Health Studies - cardiac research
Health Studies - osteosarcoma research
Education
Dedication Text (optional)
This is the text that will appear after your name on our donor reports on the website and in Focus. Examples: IMO Holly, IHO Frances, with gratitude
Dedication Notification (optional)
If you would like someone notified of your special donation, please fill out the information below.
Donation is in Honor of Someone
Donation is in Memory of Someone
No Notification Required
Donation Notification
If you would like to notify someone that you made a gift in their honor, or notify someone about a donation in memory of someone, we'll need some additional information.
Name of Person Honored
First Name
Last Name
Email Address of Honored Person
Verify Email
Address of Honored Person
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Name of Deceased
First Name
Last Name
Name of Person Who Should Receive IMO Notification
First Name
Last Name
Address for IMO Notification
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
IWF Membership
If you haven't joined yet, please consider doing so now. Your membership will run from the day you sign up until the end of our fiscal year (June 30).
Membership Donation
$20
Add 3% to my total amount to help cover the payment processing fees
