Camp Loyaltown Honor Memorial Donation Form

Gift Information

Make an Honor/Memorial donation to Camp Loyaltown today

An honor/memorial donation is a meaningful way for friends and family to honor someone special, recognize a significant achievement, celebrate a special day or make a gift in honor of someone who is deceased.

Field Is Required Enter A Gift Amount:

$500.00

$250.00

$100.00

$50.00

$25.00

Enter Amount ($10.00 Minimum)

Enter amount

Honor/Memorial Information

Honor Gift Type:

Honoree First Name:

Honoree Last Name:

Send notification of my donation to:

(An acknowledgemet card created by a person supported through our programs will be sent to the Recipient listed below. The amount of the donation does not appear on the card.)

Notification Recipient Title:

Notification Recipient Name:

Honor Gift Relationship

Notification Recipient Street 1:

Notification Recipient Street 2:

Notification Recipient City:

Notification Recipient State/Province:

Notification Recipient ZIP/Postal Code:

Comments

Billing Information

Is this donation on behalf of a Company or Employer?

Yes

Company/Employer:

Title:

First Name:

Last Name:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Email Address:

Phone Number:

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

If you donate and have not already registered, you will receive periodic updates and communications from AHRC Nassau.