GLBT History Museum Donation Form

Donations made here will be used to support the GLBT History museum now open at 4127 18th Street in San Francisco. Individuals donating over $50 automatically become members of the GLBT Historical Society. Donations of $1,000 or more become sponsors and with a number of benefits including recognition at the museum.
Donation Levels 
  Level Range
    Museum Sponsor 
$1,000 and up
    Benefactor 
$500 - $999
    Patron 
$250 - $499
    Sustainer 
$100 - $249
    Member 
$50 - $99
    Student/Low Income Member 
$30 - $49
    Museum Donation 
$10 - $29
* required information
Donation
Select Gift Frequency
I would like to make a one-time gift for the following amount:
:* $
I would like to make a recurring gift.
Gift Amount* # of Payments Payment Frequency Total Gift Amount
$ X = $
NOTE: This transaction will count as the first payment toward your total gift amount.
Donor Information
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Country:
Mail to this Address?
Phone:
Memo:
Payment Information
:*
:*
:*   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:*
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