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Donation Form
Honorary and Memorial Gifts
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*denoted required field
All
information provided is strictly confidential.
Donor Information:
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* First
Name |
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Maiden
Name |
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* Last
Name |
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Group Name
(Please provide a Group Name if the donation is from a company, alumnae group or collegiate chapter; otherwise, leave blank) |
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* Address |
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* City |
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* State/Province |
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* Zip/Postal
Code |
-
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Country |
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* Daytime
Phone |
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* E-mail
Address |
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School/Chapter
of Initiation
(if
donor is a Delta Gamma) |
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| Gift Information: |
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My
gift is:
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in honor of:
in memory of:
(full name of honoree) |
Honoree is a non-member? |
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Honoree is a Delta Gamma
(Select school/chapter) |
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Send acknowledgment of my gift to:
(Amount will not be shared;
provide full name and address) |
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| Payment Information: |
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*Amount:
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$
(in US dollars; no
commas or dollar signs, numeric digits only, 10 dollar minimum, please) |
*Charge
my
(credit card type) |
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* Name
on Card |
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*Card
Number
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(no spaces or dashes) |
*Expiration |
(format like mm/yyyy: 10/2010) |