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Make a Gift TO AL!VE AND Pay Now

Complete the information in this form to make a GIFT to AL!VE and PAY TODAY.

To change between the type of AL!VE gifts, simply click below and the form options will change:

1) Make a gift to AL!VE

2) Purchase tickets to the HGB Gala

3) Make a gift to the hospital

Donation Information

Please check one of the suggested amount or enter your own amount in last row.

Amount:

$10 gift to AL!VE

$ 10.00

$25 gift to AL!VE

$ 25.00

$50 gift to AL!VE

$ 50.00

$100 gift to AL!VE

$ 100.00

$250 gift to AL!VE

$ 250.00

$500 gift to AL!VE

$ 500.00

My Gift :

$

*

Additional Information

Type of gift:

One-time gift
Recurring gift

Frequency:

On:
Starting: Ending:

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

What brought you to the site to give today?

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Billing Information

Title:

First name:

*

Last name:

*

Country:

*

Address lines:

*

City:

*

State:

*

ZIP:

*

Phone:

*

Email:

*

Payment Information

Cardholder's Name:

*

Credit Card Number:

*

Card Type:

*

Card Expiration:

/

*

Card Security Code:

help

*

Matching Gifts

My company will match my gift

Company:

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Tribute Information (Optional)

Please complete this optional section if your gift is a tribute.

Name:

*

First name:

Last name:

*

Type:

*

Description:

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Mail a letter on my behalf to:

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