Choose event:
Stonewall Swim 2010
You have chosen:
None Of Above
I/We cannot attend but would like to make a contribution to the event:
$
Name as you would like it to appear on contributor listing:
I prefer that my/our gift be anonymous.
Name of table captain or host (if applicable):
Please use the full name and address as they appear on your credit card billing statement.
Denotes Required Field.
First Name:
Last Name:
Middle Initial:
Street Address:
City:
State:
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Day Phone:
E-mail:
Card Type:
Amex
Discover
Mastercard
Visa
Card Number:
Expiration Date:
3 or 4 Digit Code:
Stonewall Community Foundation is a not-for-profit 501(c)(3) organization. Gifts are fully tax deductible, except where goods and services have been received. Stonewall Community Foundation’s federal tax identification number is 13-3550688.
A copy of our latest annual report may be obtained, upon request, from the Foundation or from the Office of the Attorney General Charities Bureau, 120 Broadway, New York, NY 10271.
© Stonewall Community Foundation