General Donation

35th Anniversary VIP Gala Reception
Thursday, May 31, 2018

 
This Form makes a General Donation for this campaign ONLY!
If you wanted to donate in support of a particular Team or Participant
then click CANCEL below and choose Support Participant instead.
 
* Required
 
Gift Information
 
* Select A Gift Amount  
  $120.00
  $60.00
  $35.00
  Enter a different amount ?
  Yes, you can display the amount of my donation publicly.
 
Donor Information
  Display Name: First and Last Name      Company Name
  Title:
* First Name:
  Middle Name:
* Last Name:  Please enter exactly as it appears on your card.
* Company Name:
* Email Address: ?
    Yes, I would like to receive communications from ADRC.

* Billing Address 1:  Address Line must match the address on file for your credit card.
  Billing Address 2: ?
* City:
* State / Province:
* ZIP / Postal Code: ?
* Country:
  Donor Phone Number: ?

* Credit Card:
Visa
MasterCard
American express
* Card Number:
?
* Verification Code:
?
For your safety and security, we require that
you enter your card's verification number.
* Expiration:

  CAPTCHA
Security Image:
 Get a new challenge
 
* CAPTCHA
Security Code:
?

 

  

   
 
Alzheimer's Disease Resource Center
24/7 Helpline: 1.855.732.4500
Chapter: 631.580.5100
www.ADRCinc.org
Connect with us:  Facebook    LinkedIn    Google+    Twitter 

Main Office: 45 Park Ave., Bay Shore, NY11706

Satellite Office(s):
By Appointment ONLY

33 Flying Point Rd., Suites 121/122, Southampton, NY11968
70 East Sunrise Highway, Suite 500, Valley Stream, NY 11581
100 Quentin Roosevelt Blvd., #102, Garden City, NY 11530
3 Dakota Dr, Suite 300, Lake Success, NY 11020
Walt Whitman Atrium, 33 Walt Whitman Road, Suite 208, Huntington Station, NY 11746

Alzheimer's Disease Resource Center, Inc. (ADRC) is a not-for-profit 501(c)(3) tax exempt organization.
©2013 Alzheimer's Disease Resource Center. All rights reserved.
   
Site Developed and Hosted by   ITI Computers   International Technical Industries, Inc.
Copyright 1994 - 2018 : ALL RIGHTS RESERVED