AVEY'S Donation Form
2025 Benefiting Michele Gierisch
Donor Name
*
First Name
Last Name
Company Name
*
If you are not donating from a company please input NA
Donation Level
*
Please Select
Habanero-$1,000
Tabasco- $500
Cayenne-$250
Serrano-$100
Other-submit amount with your choice of payment
We greatly appreciate any amount!
PLEASE INCLUE COMPANY OR INDIVIDUAL NAME YOU WOULD LIKE DISPLAYED ON SHIRTS & BANNER
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Form of payment
*
Please Select
Check-SANDI SENS WARD
Venmo- Sandi-Ward-2
Cash
We can pick up checks if local
LOGO UPLOAD FOR FACEBOOK POST
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: