Donation Form - moveINment Your InformationName(Required) First Last Donation Privacy Do not include my name in the Dégagé annual report. Email(Required)Your receipt will be emailed here. Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneContact in future It's okay to contact me in the future. DonationDonation Amount(Required)Choose how much you would like to donate. $25 $50 $100 $250 Other amount Other Amount In addition to receiving an email acknowledgement of your gift, would you like an acknowledgement letter mailed?(Required) Yes No Processing Fees I would like to cover the processing fees for my donation. Processing Fees Price: $0.00 Processing Fees Option Price: $0.00 Total Credit Card NameThis field is for validation purposes and should be left unchanged. Δ
