Thank you for your recurring donation to UK St. Claire!
Full Name
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
How often would you like to make your recurring gift? (All recurring gifts will be charged on the 15th and indefinite unless specified)
*
Monthly
Quarterly
Annually
Other
If other, please specify:
Please direct my gift to the following:
*
Please Select
Health & Wellness
Education and Career Development
Quality of Life
Split My Gift
Please divide my gift between the following funds (provide dollar amount):
*
Is this gift in honor or in memory of someone?
*
Yes
No
Per the previous question, please select one of the following:
Honorary Gift
Memorial Gift
In honor of (name, occasion):
*
In memory of (name):
*
Would you like us to send an acknowledgement of this donation to the individual or a family mamber of the recognized individual? (The amount will not be disclosed.)
*
Yes
No
To whom should we send the acknowledgment?
*
First Name
Last Name
Relationship to honoree (if applicable):
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Recurring Donation:
*
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next
( X )
Monthly Recurring Gift
USD
for each
month
Quarterly Recurring Gift
USD
for each
three months
Annually Recurring Gift
USD
for each
year
Credit Card
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to add an end-date for your recurring donation?
Yes
No
If yes, what date would you like your recurring gift to end?
-
Month
-
Day
Year
Date
Submit
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