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My Donation Amount
*
$1,000
$500
$250
$100
$50
$25
$
My Donation Schedule
One Time
Monthly
Please collect payments from me on this schedule from now through:
(mm/dd/yyyy)
Contact Information
Name
*
First Name
Last Name
Acknowledgement Name (if different from above)
Email
*
Verify Email
*
Phone
Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Gift Details (Optional)
In Honor/In Memory
Is this donation made in honor or in memory of an individual?
Yes--In Honor
Yes--In Memory
No
This donation is in honor of:
This donation is in memory of:
Please send notification of this gift to:
If possible, please include a mailing or email address for this person so we can notify them of your generosity.
Please send notification of this gift to: (OPTIONAL)
If possible, please include a mailing or email address for this person so we can notify them of your generosity.
When we notify them of your donation, may we tell them your name?
Yes--you may tell them my name.
No--please tell them that a donation was made by an anonymous donor.
When we notify them of your donation, may we share your mailing address with with them?
Yes--you may share my mailing address with them.
No--please don't share my mailing address with them.
Will this gift be matched by your employer?
Yes--contact me for more information.
No.
Comments/ Questions