Connecticut Land Conservation Council · Individual Giving

Donation Information

Amount

*

$250

$100

$50

$25

$15

$10

$

Donation Schedule

Contact Information

Name

*

First Name

Last Name

Email

Cell Phone

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Is this gift anonymous?

Yes, I prefer to make this donation anonymously.

Matching Gift Program

My employer will match my gift.

Employer / Company Name

Is this a tribute gift?

No

Yes, this gift is in honor of someone

Yes, this gift is in memory of someone

Name of the person this tribute gift is honoring

First Name

Last Name

Name of the person this tribute gift is in memory of

First Name

Last Name

May we notify the honoree of your gift?

No

Yes

Honoree's Email Address

Honoree's Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

May we notify a family member or friend of your gift?

No

Yes

Name of family member or friend to be notified

First Name

Last Name

Family or Friend's Email Address

Family or Friend's Mailing Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Comments (e.g. additional donor names)

Would you like to be added to the CLCC email list for up-to-date information on conservation news around the state?

Yes

No