Central Association of the Miraculous Medal Secure Online Donation Form


Secure Online Donation Form

Please note that fields with an asterisk (*) are required.

*Donation Amount $:  .00         
*Donation Frequency: 

If you chose a monthly frequency, please choose the date you would like for us to charge your account:

*First Name:  *Last Name: 
*Address 1:  Address 2: 
*City:  *State/Province: 
*Zip Code/Postal Code:  *Country: 
*Email:  *Phone #: 


*Credit Card Type: 
*Credit Card #: 
*Exp. Date:  /

                               If this gift is being made   in honor   in memory   N/A 
Please provide Full Name of person being honored/remembered:

  Prayer intentions and comments:
  

After ensuring that all of the information above is correct,
please click the Submit Form Now button ONLY ONCE.
Multiple clicks of the Submit button will result in duplicate charges to your account.
An email confirmation will be sent to the email address you provided.

 

  
The Central Association of the Miraculous Medal
Across the street from the Shrine
475 E. Chelten Ave. • Philadelphia, PA 19144
Phone: (215) 848-1010 • Fax: (215) 848-1014 • Toll Free: 1(800) 523-3674
Send us an emailwww.MiraculousMedal.org


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