WI SGRho Centennial Celebration Donor Form
Please complete this form in its entirety.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Please select which donor level you are requesting.
*
RHOyal $100
Gold $101 - $249
Ruby $250 - $499
Sapphire $500 - $999
Platinum $1,000+
T-Shirt Size
Please Select
Small
Medium
Large
X-Large
XX-Large
XXX-Large
(Gold - Platinum levels only)
Please list below how you would like your name listed in the program & website
*
All donations are tax-deductible and contributions must be paid in full prior to June 30, 2022.
Please verify that you are human
*
Submit
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