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Donation Form
Amount
*
$2,500
$1,000
$500
$250
$100
$75
$35
$
Donation Schedule
One Time
Monthly
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
Phone
Organization/Employer
Anonymous Gift?
I wish for my gift to remain anonymous.
Additional Information
I will initiate a matching gift from my company.
I would like to discuss including LEAD Girls in my estate plans.
Is this gift in honor of or in memory of someone?
In Honor
In Memory
In Honor/Memory Of
First Name
Last Name
Send Acknowledement to (name and address)
I'd like to help cover processing costs - please add 3% to my transaction