Sponsor An Invalid

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Next Steps: Install a Payment Add-On

To accept donations via this form you will need to install one of our payment add-ons. To learn more about your payment add-on options, visit the following page (https://www.gravityforms.com/blog/payment-add-ons). Important: Delete this tip before you publish the form.

Name

First Middle Last

Email*

Enter Email Confirm Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This is...*

an honorary gift

a memorial gift

a renewal

Is this the same dedication as last year?*

Yes

Dedication

Below, please type the name of the person honored or remembered and the donor name as you would like it to appear on the brass plate attached to the bench. (Three lines of up to 25 characters, including spaces, on each line.)

Acknowledgement Card

Acknowledgement Card Recipient Name*

Enter the name as you would like it to appear on the card.

Acknowledgement Card Recipient Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Donation Amount

How much would you like to donate?*

Total

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Credit Card

Replace this field with a field specific to your payment gateway whenever possible.