PLEDGE INFORMATION  

In support of the development and programming for the
,
I/we pledge and agree to give the total of: $ ,
to begin on this date / / .


My pledge is: payable over a 3-year period
payable over a 5-year period
a one-time commitment
I would like to receive pledge reminder statements to make payments
on my pledge according to the following schedule:

Annually | Semi-Annually | Quarterly | Monthly
     
DONOR ACKNOWLEDGEMENT  

Name: *Required
ID Number:
Address: *Required
Email: *Required
Referred By:
   
GIFT ACKNOWLEDGEMENT  
 


I would like this pledge to be acknowledged as a gift from or in honor of:

NAME (if different than above): -OR- ANONYMOUS

  
     
PAYMENT  
 


Please Check Appropriate Box

* I authorize AHRA Education Foundation to automatically debit the credit card below in accordance with the pledge amount and payment schedule listed on this form. This authorization is to remain in full effect until the full amount of the pledge has been paid or the AHRA Education Foundation has received written notification of its termination.

I will submit payments on my pledge to AHRA Education Foundation in accordance with the payment schedule listed above. Please send reminders.

I am submitting the paperwork for a corporate matching gift from my/my spouse’s employer.

Please note, this form is only for NEW pledge donations. If you would like to pay for an existing pledge donation contact member services.

Please charge my credit card for my initial gift (down payment) of $
* Required only for the credit card payment option

 

  
 
Name on Credit Card:  
* Required only for the credit card payment option
Credit Card:  
* Required only for the credit card payment option
Credit Card Number:  
* Required only for the credit card payment option
Verification/Security Code:
(See back of card)
Expiration Date: /  
* Required only for the credit card payment option