09-December-2007
Website Launch
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Donate - One time Donation
Fileds marked with * are mandatory
First Name:
*
Middle Name:
*
Last Name:
*
Institution:
Address:
*
Postal Code:
Telephone:
*
Fax:
Mobile:
E-mail:
*
URL:
Type of Contribution:
Personal
Corporate
Type of Listing:
Real Name
Anonymous
Beneficiary(if available):
I would like to donate as a:
Friend $25 - $99
Supporter: $100 - $299
OR
:
to contribute to as a:
ALFA (A)
BETA (B)
ALFA & BETA (A B)
A
B
A
B
A
B
A
B
Sponsor
$
300
$
500
$
600
$
700
$
800
$
900
$
1000
$
1200
Partner
(A)
$1500 - $4999
(B)
$1500 - $4999
Principal
(A)
$5000 - $9999
(B)
$5000 - $9999
Patron
(A)
$10000 - $19,999
(B)
$10000 - $19,999
Benefactor
(A)
$20,000 +
(B)
$20,000 +
(Donors who wish to contribute to ‘Cedar Fund’, please check for more details)
Total ALPHA: $
Total BETA: $
Grand Total: $
Mode of Payment:
Cash
Check
Bank Transfer
Master Card / Visa Card
Other
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