GIVING LEVEL

For donations at the Patrons' Circle Level ($2,500 and above), please contact Tanja Eikenboom at 502.561.7969

Director's Circle ($1,500 to $2,499)

President's Council ($1,000 to $1,499)

Benefactors ($500 to $999)

Supporters ($250 to $499)

Associates ($100 to $249)

Friends ($1 to $99)

Donation amount:$

PERSONAL INFORMATION

Title: Mr. Ms. Mrs. Dr.

First Name:

Last Name:

Address:

City: ST: Zip:

Phone:

Email:
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If necessary, please add special designation for your gift.

PAYMENT INFORMATION

Card Type: Visa MasterCard American Express Discover

Name on Card:

Card Number: A value is required.

Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 Please select an item. 2010 2011 2012 2013 2014 2015

3 or 4 digit security number
Located on the front or back of your card

Billing address is same as above

Billing Address:

Billing City: Billing State: Billing Zip: