AMDA Foundation - Make a Contribution to AMDA Foundation Futures Program

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Make a Contribution to AMDA Foundation Futures Program

All contributions will be dedicated to the 2008 AMDA Foundation Futures Program.


Fields denoted with an asterisk () are required.*

Section A - Contributor's Information
First Name: *
Middle Initial:
Last Name: *
Credentials:
Address 1: *
Address 2:
City: *
State: *
Zip Code: *
Phone: *	Please enter your primary telephone number using the format XXX-XXX-XXXX.
Fax:	Use the format XXX-XXX-XXXX.
Email: *
AMDA Member: *	Yes No Are you an AMDA member?
Section B - Contributor's Preferences
Listing Options: *	Please list my name Withhold my name from lists Your name will be published in the list of contributors for the current year (see Fundraising/Contributions/200X Contributors) if you select Please list my name. Otherwise, select Withhold my name if you prefer to make an anonymous contribution.
Other Option:	My employer has a matching gift program
Section C - Contribution Selection
Amount: *	$25 (minimum) $50 $75 $100 $250 $500 $750 $1,000 Other
Other Amount:	Please enter an amount for other only if you selected "Other" above. Enter this amount using only whole numbers and without any punctuation i.e. "2000". The minimum contribution is $25.