Choose Your Team
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Annual Fund


C2Adopt strives to build a healthier, stronger and more caring community by being a unique, innovative and diverse center for adoptive placement & support.
First Name:
Last Name:
Address:
City:
State: (ignore for non-US transactions)
Zip Code:
Country:
Email Address:
Confirm Email Address:
Preferred Phone:
Title (optional):
Organization (optional):
Credit Card Billing Address
 
 If the address where you receive the credit card bill is different than above, please enter it here.
Address:
City:
State:
Zip Code:
 

Unrestricted use, wherever the need is greatest Yes
Donald Samuel Jefferson Fender Fund Yes
Roots & Wings Leaf(ves) $250/leaf (Please provide child's name & DOB)
Do you wish to have this gift remain anonymous? Yes
In honor of (provide name):
In memory of (provide name):
Please acknowlege this gift to (please provide name and address):
This gift is eligible to be matched by my employer (please mail us the form) Yes
Charge Amount:
  $10.00
$20.00
$30.00
$50.00
$75.00
$100.00
$200.00
$300.00
$500.00
$1,000.00
  Other Amount --> $
  You can choose any amount you'd like by checking the box for the amount you'd like to give, or by checking the Other option and entering a custom amount in the blank field.
Make this a Recurring Transaction?  
By default your card will only be charged today, with no recurrence set up. However, you can use the fields below to specify a recurring payment on the schedule of your choosing. Change the recurrence to specify how often your transaction will be processed. Specify an end date to stop transactions after a certain point in time (if you are unsure, use the expiration of your credit card).
Recurrence:
End Date: Not required. Defaults to your card expiration month and year
Pay by Credit Card  
Card Type:
Credit Card Number:
Credit Card Expiration (mm/yy): /
Name On Card:
C V V Value: