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2024 Give Miami Day Pledge Form

#GMD2024
Now you don't have to wait until Give Miami Day to support The Melissa Institute!

Complete the pledge form below to give us permission to charge your credit card for the amount indicated on Give Miami Day, 11/21/2024. The Miami Foundation will also make a bonus gift for every donation between $25 and $10,000 received until November 20th!

Please Note:
The Give Miami Day platform requires a minimum of $25 for each donation. This form is for a single transaction only, and does not provide authorization for any additional or unrelated charges to your credit card.

Thank you for your support!
1.What is your full name?(Required.)
2.What is your email?(Required.)
3.What is your phone number?(Required.)
4.Are you donating on behalf of a company? If so, what is the name of the company?
5.What is your desired donation amount?(Required.)
6.Would you like to cover the credit card transaction fee?(Required.)
7.Please input your Credit Card information(Required.)
8.What is your billing address?(Required.)
9.Would you like to dedicate your donation to someone?
10.By submitting this donation I allow The Melissa Institute for Violence Prevention & Treatment to process my credit card on Give Miami Day - Thursday, November 21, 2024 via the givemiamiday.org website.(Required.)