Capital Campaign Donation (Credit Card) Step 1 of 4 25% 1. Your InformationName* First Last Is this donation also from a spouse/partner?* Yes No Second Donor Name First Last I am a(n)* Alumni Parent Graduation Year Child's Name Child's Graduation Year Email* Cell Phone 2. Capital GiftMaryland Hillel relies on the donations of alumni like you to run its programs and initiatives. We ask that your capital campaign gift be over and above what you have given annually in the past. If you are not an annual campaign donor, Hillel requests your permission to designate 10% of your gift to its annual campaign.I would like to pay an existing pledge* Yes No Please enter the amount you would like to pay:* I am:* An existing annual donor Not an existing annual donor My capital gift is for:* General Gift Naming Opportunities Alumni Brick General Gift* One Time Gift Annual Gift Monthly Gift General Gift Amount* Total Gift Amount: Amount to be charged annually:* Amount to be charged monthly:* Naming Opportunity- I would like to be contacted by:* Phone Call Email Naming Opportunity- Please indicate desired size of gift, and what you wish to name (not guaranteed until finalized with Hillel)* Alumni Brick* $5400 (12"x12") 6 lines of text/ 15 characters per line and recognition on naming wall $3600 (12" x 12") 6 lines of text/ 15 characters per line $1800 (8" x 12") 4 lines of text/ 15 characters per line $5400 (12"x12") 6 lines of text/ 15 characters per line and recognition on naming wall*Full AmountFive Year PlanMonthlyWhat would you like your brick to say? (6 lines of text/ 15 characters per line)$3600 (12"x12") 6 lines of text/ 15 characters per line*Full AmountFive Year PlanMonthlyWhat would you like your brick to say? (6 lines of text/ 15 characters per line)$1800 (8" x 12") 4 lines of text/ 15 characters per line*Full AmountFive Year PlanMonthlyWhat would you like your brick to say? (4 lines of text/ 15 characters per line) 3. PaymentTotal $0.00 Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name My gift is* In Honor of Someone In Memory of Someone Not in Honor or in Memory of Someone Name of Honoree Contact information of honoree or person(s) to be notified of donation.Keep my gift anonymous* Yes No My employer offers a matching gift program Yes No Name of Employer Employer's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code HiddenData Source HiddenLGL Form ID
