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I would like to donate:
*
$1,000
$500
$250
$100
$50
$
Donation Schedule
One Time
Monthly
Quarterly
Yearly
Bi-Monthly
Your Name:
*
First Name
Last Name
Spouse/Partner Name
Organization Name:
Please complete if the donation is from the organization
Email:
*
Your receipt will be sent to this email address.
Verify Email
*
Phone:
Address:
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
This gift is anonymous:
*
No
Yes
Preferred Annual Report Name
Prefix
First Name
Last Name
Suffix
This gift is being made in honor or in memory of someone:
*
Yes
No
Tribute Type:
*
select one
In honor of
In memory of
In Honor/Memory of:
*
First Name
Last Name
Please notify the below of this tribute:
First Name
Last Name
Notification Contact Info (please provide either a mailing or email address in order for your tribute to be sent):
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Notification Email:
Verify Email
My employer will match my donation:
Please submit your company's gift matching form to Human Resources for MDI to receive your match.
Yes
No
Employer Name for Match
I would like to add 3% to my total amount to cover the payment processing fees.
