Donation Form
I am pleased to support Genesis Home with my gift of $__________
__$50 __$100 __$250 __$500 __$1,000 __$1,989 (1989 Society)
¨ I pledge my gift to be payable by the end of the calendar year.
¨ I would like to talk; please call me.
¨ I would like to learn more about the 1989 Society.
This gift is in ¨ Honor of/ ¨ Memory of ______________________________________
Personal message__________________________________________________________
Please send an acknowledgement of this gift
to________________________________________________________________
Address_____________________________________ City_________________
State_________Zip______
from______________________________________________________________
Address______________________________________ City________________
State_________Zip______
Email_______________________________Phone________________________
Preferred Salutation (for gift acknowledgment)_______________________________
-or- ¨ I prefer that this gift remain anonymous.
¨Check enclosed (payable to Genesis Home)
¨Credit Card
Acct.#__________________________________Exp.Date__________/______
Name on card____________________________________________________
___ one-time gift ___monthly ___bi-monthly ___ quarterly
Thank You!
Please mail to:
Genesis Home
PO Box 25426
Durham, NC 27702