Southampton History Museum · General Donation Form

Donation Amount: *

$10

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Your Contact Information

Name *

First Name

Last Name

Include a spouse/partner as a joint donor for this donation? *

If yes, your spouse will be included on tax receipts and acknowledgments for this gift.

Yes

No

Spouse's Name

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Is this gift anonymous? *

Yes

No

If we have your permission to publicly acknowledge this contribution, how you would like your name(s) printed?

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In Honor/In Memory Gifts

Is this gift in memory or in honor of someone? *

No

In Memory of

In Honor of

Name for In Memory or In Honor of Gifts

Dedication

Should we notify anyone of this donation? *

Select "yes" if you would like us to notify the individual (in honor of) or the family (in memory of) for this donation.

Yes, please notify the honoree

Yes, please notify the family/friends (memorial donation)

No

Who to Notify for In Honor/In Memory of Gift:

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Last Name

Notification Address for In Honor/In Memory of Gift

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City

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