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Donation Form

to 4C

The option to make this amount a monthly contribution is at the bottom of this form.

Contact Information
Please spell out state name.
I am a:
How would you like your name to appear in acknowledgements of your donation?
Designation (Optional)
To designate your donation for a specific fund or purpose, please enter a description of how you'd like your donation to be used.
Dedication of Gift (Optional)
To make a donation on behalf of or in memory of another person, please enter the person's name.
Additional Details

Credit Card Information
Visa MasterCard American Express Discover

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Make this a monthly payment?
Make this a monthly payment?
Your total payment will be
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