Each donor that donates, at a certain level, shall be entitled to one (1) vote to participate in the Donor Voting Process. This vote will ultimately decide how all donated money will be spent so the accuracy and completeness of the information provided on this form is essential to your participation in the voting process.

DONOR'S INFORMATION

Full Name: *

E-mail: *

Primary Phone:

(555) 555-5555

Street Address:

City, State, Zip:

YOUR DONATION

Donation Amount: * $

Donation Frequency: *

One Time (For Now...)

Monthly

Quarterly

Annually

YOUR PRIVACY

In an attempt to provide Transparency to the public, a schedule of all the donations we receive will be published on our website. However, if you prefer, you may elect to keep your name private by selecting the option below to "OPT OUT".

Privacy Option: *

OPT IN - Your Full Name will be made Public.

OPT OUT - Your Full Name will be kept Private.

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