St. Agnes Academy - St. Dominic School
On-Line Donations
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Donor Information
* = required
Full Name *
Affiliation *
Year of Graduation     (4 digits, if applicable)
Address Line 1 *
Address Line 2  
City *
State/Province *
Postal/Zip Code *
Daytime Telephone *
Email *
Gift Designation

Make a Gift Now $
Make a Pledge $ (Pay by June 30)

* I would like this gift to be directed to:
$ Annual Fund
$ Capital
$ Endowment
$ Other (Please Specify)
St. Agnes Academy-St. Dominic School Giving Levels
St. Catherine Society ($10,000 & above)
Siena Society ($5,000-$9,999)
Veritas Society ($2,500-$4,999)
President's Club ($1,000-$2,499)
Dean's Club ($500-$999)
Dominican Club ($200-$499)
Aquila Club ($1-$199)
Payment/Pledge Information
I would like to contribute:
Please charge/bill me *
Monthly         with payment/installments of   (Amount US$)
One-time Gift  
Your credit card details will be kept securely on file only if needed for installment payments
Payment/Pledge Type *
Please indicate how you would like your name(s) to be recognized in our Donor Listings.
I wish for my name to remain anonymous
Matching Gifts?
Please indicate whether your employer or your spouse's employer will match your gift.
  Yours | Spouse | Organization Name(s)
Yes, matching form will be sent later
No, matching not available  
Please fax your form to Tami Shepard at 901-435-5866 or mail to Tami Shepard, St. Agnes Academy-St. Dominic School, 4830 Walnut Grove Rd, Memphis, TN 38117. For more information please call 901-435-5818.

In Honor / Memory of
I would like this gift to be in Honor / Memory of:
      In Honor   In Memory
  Please send an acknowledgment of my gift to:
Special Instructions
Any special instructions we should know?

Thank You! Your receipt will be mailed to the above address.

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