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National Council Donations
Donation Levels 
  Level Range
    $1000 
$1,000 and up
    $500 
$500 - $999
    $250 
$250 - $499
    $100 
$100 - $249
    $50 
$50 - $99
    $25 
$25 - $49
    Other 
$10 - $24
* 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:*
Phone:
Email Format:HTML    Plain Text

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:*

Matching Gift Information
Will this donation be potentially matched?
If you know the following information regarding the matching gift, please complete.
Company Name:
Matching Gift Amount:$
Type the characters you see in the picture below:*
By clicking Submit,
your credit card will be processed