NCJW Chicago North Shore · 2024 Mother's Day Initiative Card Order Form

Total Number of Cards Ordered

*

(Max 10 cards per order form)

Please enter your total Mother's Day donation in the box below.

The minimum donation for one card is $18.

Please enter your total Mother's Day donation in the box below.

The minimum donation for two cards is $36.

Please enter your total Mother's Day donation in the box below.

The minimum donation for three cards is $54.

Please enter your total Mother's Day donation in the box below.

The minimum donation for four cards is $72.

Please enter your total Mother's Day donation in the box below.

The minimum donation for five cards is $90.

Please enter your total Mother's Day donation in the box below.

The minimum donation for six cards is $108.

Please enter your total Mother's Day donation in the box below.

The minimum donation for seven cards is $126.

Please enter your total Mother's Day donation in the box below.

The minimum donation for eight cards is $144.

Please enter your total Mother's Day donation in the box below.

The minimum donation for nine cards is $162.

Please enter your total Mother's Day donation in the box below.

The minimum donation for ten cards is $180.

Total Donation

*

$

Contact Information

Name

*

First Name

Last Name

Email

*

Verify Email

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Card #1 Information

Card #1 Recipient Name

First Name

Last Name

Card #1 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

1. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

1. In Memory/In Honor Name:

1. How would you like your card to be signed

Card #2 Information

Card #2 Recipient Name

First Name

Last Name

Card #2 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

2. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

2. In Memory/In Honor Name:

2. How would you like your card to be signed

Card #3 Information

Card #3 Recipient Name

First Name

Last Name

Card #3 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

3. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

3. In Memory/In Honor Name

3. How would you like your card to be signed

Card #4 Information

Card #4 Recipient Name

First Name

Last Name

Card #4 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

4. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

4. In Memory/In Honor Name:

4. How would you like your card to be signed

Card #5 Information

Card #5 Recipient Name

First Name

Last Name

Card #5 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

5. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

5. In Memory/In Honor Name:

5. How would you like your card to be signed

Card #6 Information

Card #6 Recipient Name

First Name

Last Name

Card #6 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

6. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

6. In Memory/In Honor Name:

6. How would you like your card to be signed

Card #7 Information

Card #7 Recipient Name

Prefix

First Name

Last Name

Suffix

Card #7 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

7. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

7. In Memory/In Honor Name:

7. How would you like your card to be signed

Card #8 Information

Card #8 Recipient Name

First Name

Last Name

Card #8 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

8. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

8. In Memory/In Honor Name:

8. How would you like your card to be signed

Card #9 Information

Card #9 Recipient Name

First Name

Last Name

Card #9 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

9. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

9. In Memory/In Honor Name:

9. How would you like your card to be signed Copy

Card #10 Information

Card #10 Recipient Name

First Name

Last Name

Card #10 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

10. In Memory/In Honor (select one)

If nothing is selected, default will be In Honor Of

In Memory Of

In Honor Of

10. In Memory/In Honor Name:

10. How would you like your card to be signed Copy