Fellowship Hall · Tell us how you'd like to make a difference

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Donation Form

Organization Information

This donation is on behalf of a business, faith-based, civic, or other organization.

Name of Organization

Your Name:

First Name

Last Name

Your Phone

Your Email:

Verify Email

Your Address:

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Where would you like your donation to work?

Annual Fund: for Daily Operations

Partner-Scholarship Program: To Help Someone get into Treatment

A Brick in Honor or Memory of a Loved One: $100

Brick pavers are 4” x 8” and offer 3 lines of text, 18 characters (including spaces and punctuation) on each line.

Each line will be centered; all letters are capitalized for uniformity.

Brick Paver 1

Brick Paver Line 1 (18 Characters)

Brick Paver 2

Brick Paver Line 2 (18 Characters)

Brick Paver 3

Brick Paver Line 3 (18 Characters)

Is this gift in on honor or in remembrance of a loved one?

Yes, In Memory of

Yes, In Honor of

What is the name of the person you are honoring or remembering?

First Name

Last Name

Would you like us to notify someone about your gift in tribute?

Yes

Who would you like us to notify?

First Name

Last Name

What is the address of the person to notify?

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Would you like your gift to be anonymous?

Yes

Add 3% to my total amount to help cover the payment processing fees