Confirm your eligibility
By checking this box,
I certify that the following
statements are true and
accurate:
- This contribution
is made from my personal
funds and is not
drawn on an account
maintained by a corporation,
labor union, or national
bank; and
- I am a U.S. citizen
or lawfully admitted
permanent resident
and this contribution
will not be reimbursed
by another person.
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Your Full Name:
(as it appears on your credit card) |
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Billing
Address:
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Street Address: |
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City: |
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State: |
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Zipcode: |
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Phone Number: |
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Fax Number: |
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E-Mail Address: |
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Required
fields for all
donations are marked
with an asterisk
(*)
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Occupation |
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Employer |
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I want to donate the above amount: |
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If my donation is recurring,
please bill me for:
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Credit Card Number:
(Please enter numbers only,
no dashes or other punctuation)
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*
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Credit Card
Expiration Date: |
Month *
Year * |
Credit Card CVV Security Code:
(What's this?) |
* |
I have read and agree to the Donation Policies below. |
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You will have the opportunity to review your donation details on
the next page before
your credit
card is charged.
By law, the
maximum amount
an individual
may contribute
is $5,000 per
calendar year.
Contributions
are not tax deductible
as charitable
contributions
for federal income
tax purposes.
Federal law requires
us to obtain
and report the
name, mailing
address, occupation
and name of employer
for each individual
whose contributions
aggregate in
excess of $200
per calendar
year. Contributions
by corporations,
foreign nationals
(non-green card
holders), labor
unions, federal
government contractors,
and minors under
the age of 16
are prohibited.
Security, Privacy, Refund & Recurring Donation Policies |
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