2021 Breakthrough Honor Roll

Sustaining Member Pledge Form

Thank you so much for your interest in becoming a sustaining member of the Breakthrough Honor Roll! Your support will provide the breakthrough that can change everything for a child, their family and our community.

Please complete the following pledge form below. At the end of the form there is a link to make your first payment or set up monthly payments.

Question Title

Member Information

Donor Name(s)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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I/we wish to join the Breakthrough Honor Roll as a sustaining member with a pledge at the following level:

$1,000 ($83/month) for 5 years

$2,500 ($208/month) for 5 years

$5,000 ($416/month) for 5 years

Other amount greater than $1,000 for 5 years

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After submitting this form, you will be provided with a link to make your first gift now. For future years and/or if you would like to make your first pledge payment later this year, please indicate the preferred month when you would like us to send you a pledge reminder.

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For recognition purposes, the donor(s) should be identified as follows in donor listings and communications:

I/we prefer to remain anonymous.

Please list me/us as the following:

2021 Breakthrough Honor Roll

Sustaining Member Pledge Form

Question Title

Member Information

Question Title

I/we wish to join the Breakthrough Honor Roll as a sustaining member with a pledge at the following level:

Question Title

After submitting this form, you will be provided with a link to make your first gift now. For future years and/or if you would like to make your first pledge payment later this year, please indicate the preferred month when you would like us to send you a pledge reminder.

Question Title

For recognition purposes, the donor(s) should be identified as follows in donor listings and communications:

Question Title

Any additional comments, payment preferences or additional instructions for your pledge?