DOM RETREAT CONF CENTER

Please note that fields with an asterisk (*) are required.
You can use a Visa or Mastercard with this form.

*First Name	*Last Name

*Street or PO Box	Apartment/Suite Number

*City	*State
*Zip	*Country
*Email	Phone

Use our Giving Table below as a guide for either your One-Time or Monthly Gift

$5 - $59 Friend
$1,000 - $4,999

$60 - $119 - Patron
$5,000 - $9,999

$120 - $499 - Sponsor
$10,000+ - Ministry Partner

$500 - $999 - Supporter

Please check that all of your information is entered correctly
*Please designate one. Use my gift for:
*CC/Debit Card	*Exp /
*Select Your Giving Frequency
Using our Giving Levels table, please enter your contibution amount
Enter the contribution amount $ (xx.xx)*

As a **Monthly or **Quarterly donor, I agree to have my card debited as indicated.
I may discontinue this donation arrangement at any time by notifying Dominican Retreat & Conference Center. Please select one Consent Option below.

*Giving Consent

If you are purchasing a chapel or conference chair please enter the name to be inscribed on the plaque in the box below. Remember to indicate whether this is a memorial or honorarium.

I want to remain anonymous No Yes

After ensuring that all of the above information is correct,
please click the "Submit Form Now" button only once.