2012 Year-End Appeal Donation Form

My name is Michael Lagana and I’m a meso advocate, community member and caregiver. Had you met me a few years ago, you would have learned that I am someone who enjoys a good challenge. Back then, I would have also told you that I purposely seek activities that stretch my abilities physically and mentally. Heck, I used to climb some of the tallest peaks in the world just for fun and a sense of accomplishment! Little did I know that the biggest challenge of my life was yet to come.

Read more of Michael's letter...

Donation Levels 
  Level Range
    $50,000 Level 
$50,000 and up
$25,000 - $49,999
$10,000 - $24,999
* required information
Select Gift Frequency and Amount
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:*
Address Line 1:*
Address Line 2:
ZIP/Postal Code:*
Payment Information
Payment Method
:*   Explain
Credit Card Type:*
Credit Card Expiration:*
Billing Information
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