Alum Treatment Donation Form

Thank you for joining the campaign! These funds are deposited in a dedicated insured account invested securely in U.S. Treasury Bonds. We need your contact information both for acknowledgement preference and to reach you in the event that we do not attain our goal. In that case, you will be offered to have your funds returned or redirected.

When you hit the submit button, you will be redirected to the PayPal payment screen. After making payment, you will be redirected back to the web site. Thank you again!

First Name

Last Name

Phone (mobile preferred)

(###)

###

####

Maiilng Address (road or PO Box)

Mailing Address (town/city)

Mailing Address (zip code)

Public Acknowledgement

This gift is anonymous.

I/we would like to be acknowledged as a donor in FOLW publications. I understand that only names and not amounts will be listed.

Name(s) for Public Acknowledgement

Amount Being Donated

Frequency

One-time

Monthly

Annually