*Required Field
Donor Information
*
First Name:
*
Last Name:
*
Email:
*
Phone:
*
Address:
*
City:
*
State:
Non-U.S.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
US Armed Forces
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code:
Contribution Amount
Other: $
$10
$50
$25
$100
$500
$1,000
Recurring Information
Recurring
One Time
Weekly
Twice a month
Monthly
Employment Information
*
Occupation:
*
Company Name:
Compliance
*I affirm that the following statements are true and accurate:
(1)
The funds I am contributing are my own personal funds and not those of another person.
(2)
My contribution is not from the general treasury funds of a corporation, organization or national bank.
(3)
I am not a federal contractor.
(4)
I am not a foreign national who lacks permanent resident status in the United States.
(5)
I affirm that I am making this contribution via my personal credit or debit card for which I have a legal obligation to pay, and not through a corporate or business entity card or the card of another person.