Pick a Date to Donate - Disability Pride Month

Form
Pick a Date Fundraiser Donation Form

Support The Arc of the Quad Cities Area this July by picking a date and multiplying your impact
Help Us Fill the Calendar!

Every day in July is up for grabs

Each day’s number = your donation amount × $10.
(E.g., July 1 = $10, July 2 = $20, etc.)
Except for July 4th (America's 250th Anniversary)=$250 & July 26th (ADA's 36th Anniversary)=$360 special day!

Let’s celebrate pride, access, and progress—one day at a time

Choose your date(s) below and help us fill the month!

If a date doesn't appear, it's already been claimed.
How did you hear about our fundraiser?
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

My Products

July 1st

$10.00 Quantity

July 2nd

$20.00 Quantity

July 3rd

$30.00 Quantity

July 4th

America's 250th Anniversary

$250.00 Quantity

July 5th

$50.00 Quantity

July 6th

$60.00 Quantity

July 7th

$70.00 Quantity

July 8th

$80.00 Quantity

July 9th

$90.00 Quantity

July 10th

$100.00 Quantity

July 11th

$110.00 Quantity

July 12th

$120.00 Quantity

July 13th

$130.00 Quantity

July 14th

$140.00 Quantity

July 15th

$150.00 Quantity

July 16th

$160.00 Quantity

July 17th

$170.00 Quantity

July 18th

$180.00 Quantity

July 19th

$190.00 Quantity

July 20th

$200.00 Quantity

July 21st

$210.00 Quantity

July 22nd

$220.00 Quantity

July 23rd

$230.00 Quantity

July 24th

$240.00 Quantity

July 25th

$250.00 Quantity

July 26th

ADA's 36th Anniversary

$360.00 Quantity

July 27th

$270.00 Quantity

July 28th

$280.00 Quantity

July 29th

$290.00 Quantity

July 30th

$300.00 Quantity

July 31st

$310.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Form

Pick a Date Fundraiser Donation Form

My Products