Contact MLC Advancement
Gift amount and designation
Select your gift amount
Amount:
$ 50.00
$ 100.00
$ 250.00
$ 500.00
$ 1,000.00
Other
$
*
Additional information
In this section you can set up a recurring gift, mark your gift anonymous, or indicate whether this will be a tribute gift from you alone or from you and your spouse. (For tributes, you'll provide more information at the bottom of this donation form.)
Type of gift:
One-time gift
Recurring gift
Frequency:
Weekly
Monthly
Quarterly
Annually
On:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Starting:
Ending:
Ending:
Anonymous:
I prefer to make this gift anonymously. (For details, see “FAQ.”)
Tribute gift? :
No, this is not a tribute gift in someone's honor or memory.
Yes, a tribute from me to the person(s) I will list below.
Yes, a tribute from my spouse and me to person(s) below.
Billing information
If using a form fill tool, note that it auto-fills the Tribute Honoree(s) full name field at the BOTTOM of this form, which you will need to CLEAR if no tribute gift is selected.
Title:
<Please select>
Mr
Mrs
Miss
Ms
Adm
Attorney General
Atty
Capt
Cdr
Col
Dean
Dr
Frau
Judge
Lt
Lt Col
Maj
PFC
Pres
Prof
Prof Dr
Prof em
Rev
Rev Dr
Sgt
Vicar
Pastor
*
First name:
*
Last name:
*
Country:
United States
Albania
Antigua and Barbuda
Aruba
Australia
Austria
Belgium
Bermuda
Bosnia
Brazil
Bulgaria
Cameroon
Canada
Cayman Islands
Chad
China
Colombia
Cuba
Czech Republic
Denmark
Dominica
Dominican Republic
Ecuador
Egypt
Estonia
Finland
France
Gambia
Germany
Greece
Grenada
Guam
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Ireland
Italy
Japan
Jordan
Kenya
Latvia
Lithuania
Malawi
Malaysia
Mali
Marshall Islands
Mexico
Mozambique
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Nigeria
Norway
Palau
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Korea
Romania
Russian Federation
Saint Kitts and Nevis
Saint Lucia
Saudi Arabia
Serbia
Singapore
Spain
Sri Lanka
Sweden
Switzerland
Taiwan, Province of China
Thailand
Tonga
Trinidad and Tobago
Turkey
Ukraine
United Arab Emirates
United Kingdom
United Republic of Tanzania
Uzbekistan
Virgin Islands, U.S.
Zambia
*
Address lines:
*
City:
*
State:
<Please Select>
AK
AL
AR
AZ
CA
CO
CT
DE
DC
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AS
CZ
FM
GU
MH
MP
PW
PR
VI
AA
AE
AP
AB
BC
MB
NB
NL
NT
NS
ON
PE
QC
SK
YT
NU
AP1
ANT
ASU
BW
BY
BL
AR1
COA
CAS
CA1
11
TH2
TH1
DE1
DC1
GUA
CN
KOW
LI
Lus
BR2
Mau
BR1
NSW
New
NK
RU1
NLE
OST
QLD
ROO
RP
RS
Sai
SG
StJ
SP
SN
SHI
SW
TXQ
TPE
TG
TI
Tok
TO1
ZH
KO1
*
ZIP:
*
Home phone:
Email:
*
Payment information
Note: An Electronic Fund Transfer will be referred to as "Direct Debit" in gift acknowledgements, etc.
Payment method:
Credit card
Electronic Fund Transfer (EFT)
Cardholder's name:
*
Credit card number:
*
Card type:
Visa
American Express
Diners Club
Discover
JCB
Maestro
MasterCard
*
Valid from:
01
02
03
04
05
06
07
08
09
10
11
12
/
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
(Maestro/Switch/Solo only)
Card expiration:
01
02
03
04
05
06
07
08
09
10
11
12
/
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
*
Issue number:
(Maestro/Switch/Solo only)
Card security code:
*
Note: The Card Security Code is not required for Maestro, Switch and Solo cards.
Additional security
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Tribute information
If you wish to honor someone special, provide their name below and select a tribute type. Use “Description” to identify the honoree’s city and state (or special occasion, e.g. “50th birthday”).
Honoree(s) full name:
*
First name:
Last name:
*
Tribute type:
in honor of
in memory of
*
Description:
*
Mail a letter on my behalf (optional).
*
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