On-line Pledge Form 2012
Yes, I want to support the 2012 Give a Kid the Y Campaign!
I pledge to pay the following by December 31, 2012:
I pledge to pay the following by December 31, 2012:
$2500 (or more) Diamond Club
$1000 Platinum Club
$500 Gold Club
$250 Silver Club
$100 Bronze Club
Other Amount
Other Amount
Donor Information:
Donor Information:
Name:
Company:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Email Address:
Phone Number:
Club Level ($100+) donors are honored on recognition plaques in the Y lobby. How would you like to be recognized?
Club Level ($100+) donors are honored on recognition plaques in the Y lobby. How would you like to be recognized?
Not Applicable
I would like to remain anonymous.
Please acknowledge as shown below.
Enter how you would like your recognition plate to read:
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