Donor Application - Chapter Leader Circle of Giving

Donor Application - Chapter Leader Circle of Giving
Thank you for considering a donation to the Chapter Leader Circle of Giving Program!

Please complete the form below to confirm your chapter’s commitment.
Your Name*

First NameLast Name
Your Email Address*
example@example.com
Your Phone Number*

Area CodePhone Number
Chapter Name*
Current Chapter Checking Account Balance*
Donation Commitment
Financial Contribution Amount
Can your chapter provide this annually?

YesNo
Airline name and number of miles
Hotel program and number of points or nights
Other travel benefits (please specify)
Ongoing Engagement
Would your chapter be willing to mentor a recipient chapter before, during, and after the conference?*

YesNo
Are you interested in offering additional resources, such as joint events, leadership workshops, or networking opportunities with your chapter?*

YesNo
If yes, please provide details.*
Recognition Preferences
Would you like to be publicly recognized for your contribution (e.g., during national events, in communications)?*

YesNo
If you'd prefer to stay anonymous, please check here.

Anonymous
Date*

MonthDayYear
Date
Signature*
Should be Empty:

Donation Commitment