On-Line Donations
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Donor Information
* = required
Full Name *
Affiliation *
Address Line 1 *
Address Line 2  
City *
State *
Zip Code *
Country  
Daytime Telephone  
Email *
Recognition
Please indicate how you would like your name(s) to be recognized in our Donor Listings.
 
I wish for my name to remain anonymous
Credit Card Information
I would like to contribute:
Angel $50,000
Founder $20,000
Benefactor $10,000
Leader $5,000
Patron $2,500
Supporter $1,000
Other Amount (please enter below)
Total Donation Amount (US$) *
Credit Card Type *
Credit Card Number *
Expiration Date *   *
Name on Card *
Directed Donations
* I would like this gift to be directed to:
$ Annual Fund
$ Capital Campaign
$ Other (Please Specify)
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 Sally Edwards at (203)957-9655 or mail to Development Office, Waterside School, 770 Pacific Street, Stamford, CT 06902.

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


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

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