AHRC Honor/Memorial Form

Gift Information

Honor and Memorial Gifts to AHRC

A memorial or tribute gift of any amount may be made to AHRC in honor of a loved one.

With a gift of $15 or more, we will send a memorial card or a card to mark a special occasion—birthday, anniversary, graduation or wedding, for example—to a recipient you designate. The cards feature artwork created by people supported through AHRC services, and note that a contribution has been made to AHRC on your behalf (the amount of the donation does not appear on card.)

Field Is Required Enter A Gift Amount:

$500.00

$250.00

$100.00

$50.00

$25.00

Enter Amount ($15.00 Minimum)

Enter amount

Honor / Memorial Information

I would like to give in Honor/Memory of:

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.)

Title:

Notification Recipient First & Last Name:

Recipient Relationship to Honoree/Deceased (spouse, mother, sister):

Street 1:

Street 2:

City:

State:

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.

Honor and Memorial Gifts to AHRC

Honor / Memorial Information

Send notification of my donation to:

Billing Information

Credit Card Information:

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