Georgia River Network Secure Contribution Form

Georgia River Network
Secure Online Membership Contribution Form

For your security, this form will not work if you use the Autofill feature of your browser.

First Name: *
Last Name: *
Address 1: *
Address 2:  
City: *
State: *
Zip Code: *
Email: *
Phone: *

If this is a Memorial Gift, please provide the name of the person being memorialized below:
If this is an In Honor Gift, please enter the name of the person being honored below:

For a Memorial or In Honor Gift, please notify:
State: Zip code:

Please choose your membership type: *  Individual Membership   Organizational Membership 

Now, select your membership level: * .00 (no commas, please)

Please choose a donation frequency: * 

Payment Type: *  Credit Card   Check 
If by Credit Card:    If by Check:   
Credit Card Type: * Routing Number: * Where do I find this?
Credit Card Number: * Checking Account: * Where do I find this?
Expiration Date: * /

 Yes   No     Please send me my free set of river notecards for my donation of $100 or more.
 Yes   No     I give permission to share my name and contact information with other conservation organizations.
 Yes   No     My company has a matching gift program. I will mail the form to you.
 Yes   No     Sign me up for monthly News Stream emails.
 Yes   No     Sign me up for email action alerts (GEAN).

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 e-mail confirmation will be sent to the e-mail address you provided.

About SSL Certificates

Georgia River Network is classified by the IRS as a 501(c)3 organization.
Contributions are tax deductible. Thank you!

Georgia River Network
126 S. Milledge Avenue, Suite E3
Athens, GA 30605
Ph: 706-549-4508 / Fax:706-549-7791
For more information, write to

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