Memorials and Tributes

Please fill out the following information to make a donation. At the bottom of the form, you can designate the family member that we will notify on your behalf of the gift. You will also have the opportunity to designate whom this gift is being made in honor or in memory of and leave remarks that will be included in your card to the family member. If you have any further questions regarding this donation, please call 404.728.6044.

To make a credit card donation over the phone please call 404-728-6044 or mail to: Georgia Chapter, Alzheimer’s Association, 41 Perimeter Center East, Suite 550, Atlanta, GA 30346.
* required information
Memorial or Tribute Donation
Donation Amount
:* $
Donor Information
Title:
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:
Email:*
Payment Information
Payment Method
:*
:*
:*   Explain
Credit Card Type:*
                  
Credit Card Expiration:*
Billing Information
If the billing information is the same as the contact information check this box.
If not please fill out the information below:
:*
:
:*
State:
:
:*
Country:*
Person to Notify of the gift
Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Type of donation::*
Gift made in memory of/ in honor of::
Remarks:
By clicking Submit,
your credit card will be processed