Edlavitch DCJCC Donation Form: Make a tribute gift to the Edlavitch DCJCC Annual Fund

FY12 Washington DCJCC Annual Fund Campaign

Any gift, large or small, is appreciated.

Honor a special person or celebrate the life of a loved one by making a tribute gift today. Your donation will support our Annual Fund, which allows us to present the highest caliber programming in the arts, education, social action, health and wellness, and community engagement. Your generosity demonstrates your commitment to the values of the Edlavitch DCJCC and the vibrant community that we all share.

Once your gift is received, the Edlavitch DCJCC will send a personalized card to the person or family you are honoring in recognition of your gift.

Enter a gift amount: Required

$250.00

$180.00

$150.00

$118.00

$72.00

$36.00

Other Enter amount.

Choosing this option will automatically repeat this gift transaction every month for 12 months. Required

Yes, automatically repeat this gift every month.

Please check this box to make a tribute gift. Additional fields will appear below to allow you to enter your tribute information.

I would like my gift to be a tribute.

Honoree Name:

Please Notify (Recipient Name): Enter the name of the person to be contacted regarding this gift. The EDCJCC will send a personalized card to the individual or family honored. The recipient information is for you to specify whom you wish to receive this card and may be left blank.

Recipient Address:

Recipient Address Line 2:

Recipient City:

Recipient State:

Recipient Zip Code:

Message Body: Use this space to enter a brief message to be included in the tribute card sent to the recipient.

Matching Gift: Please check this box to submit a matching gift form. See below for additional information.

Yes

Billing Information

Title:

First Name: Required A first name is required.

Last Name: Required A last name is required.

Address: Required A street address is required.

Address Line 2:

City: Required A city is required.

State: Required A state or province is required.

Zip Code: Required A zip or postal code is required.

Email Address: Required An email address is required.

For your privacy, subscribers can unsubscribe using any email or login to change communication preferences.

Yes, I would like to receive communications from the EDCJCC.

Donor Recognition Name(s): How would you like to be recognized in EDCJCC materials?

Payment Information

Credit Card Type:

Visa

Discover

American Express

MasterCard

Credit Card Number: Required Credit card number is required.

CVV Number: Required CVV number is required.

What is this?

Select month of credit card Expiration Date: Required Select Expiration Year

Matching Gift

Employer Name:

This information will be used to contact your employer for information on their Matching Gift program.

Street Address:

City:

State:

Zip Code:

Phone Number: