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Supporting Sample Active Impact Event

Your Gift

Gift Option*

One-Time

Gift Amount*

Gift Amount*

$ /Rep

Maximum Amount to Donate (Optional)

$ Total

Credit my gift to a participant or team (optional) Dedicate my gift in honor or memory of someone (optional)

Please provide the name of the participant or team you would like to credit:*

I'd like to dedicate this gift:*

In honor of someone or a personal milestone In memory of another's life

Dedication First Name:*

Dedication Last Name:*

How would you like send acknowledgment?*

Send an email Mail a letter I prefer not to send an acknowledgment

Personalized Message (optional):

Sent From (optional):

Recipient First Name:*

Recipient Last Name:*

Recipient Email Address:*

(ex: example@gmail.com)

Personalized Message (optional):

Sent From (optional):

Recipient First Name:*

Recipient Last Name:*

Recipient Address:*

Recipient Address 2:

Recipient City:*

Recipient State:

Recipient Zip Code:

Recipient Country:

How would you like to receive your tax receipt?*

Email Mail

Gift Matching & Corporate Giving

I'd like to see if my employer will match this gift I'd like to make this gift on behalf of my company

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Gift Match: Min / Max

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Payment

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{accountType} ending in {accountLastFour}

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Your Information

Name*

First Name

Last Name

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Title*

Mr. Mrs. Ms. Mx.

High School Graduation Year

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Donate with Credit Card

Donate {amount}

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