One moment please...
Annual Pledged Amount = $300
*
$25
-
Per Month For 12 Months
Donation Schedule
Monthly
End Date
*
Enter Last Donation Date (MM/DD/YYYY) = Today + 11 Months
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
How did you hear about us and the "25 Club"?
*
Ameriprise
Board Member
Campaign Solicitation
Staff
Other
Instructions: Upon submitting, please "click" on the "PayPal" link and either enter your existing PayPal information OR enter your Credit Card Information and create a PayPal Account.