Participant Support Billing

17th Annual West End Walk for Alzheimer's
Saturday, September 7, 2019

This donation is to support The Arbors Assisted Living @ Islandia, Team Captain Ann Marie Brew

 
* Fields in red and marked with an asterisk are required.
 
Gift Information
 
* Donation Amount ?
  Yes, you can display the amount of my donation publicly (uncheck to hide amount)
  Yes, you can display my name publicly (uncheck to display "Anonymous")
 
Donor Information
  Display Name: Display My Name      Display 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 this organization.

Billing Information
* 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:
  Phone Number: ?
  Your tribute, as you would like it to appear publicly:  (Optional)

* 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:
?   CAPTCHA: Used to tell humans and computers apart.
A CAPTCHA is a program that protects websites against robots by generating and grading tests that humans can pass but current computer programs cannot.
What's this?
 
    
   
 
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
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 - 2019 : ALL RIGHTS RESERVED