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Donations for UH Live Streaming

Please fill out the information below to complete your Tribute or Donation.

I would like to make a one-time gift of

		$18.00
		$25.00
		$50.00
		$100.00

Other amount $

Would you like to remain anonymous?

Yes

Please check if you do not want your name to appear in our publications

This gift is a tribute in

	honor
	memory
	appreciation
	thinking of you

Please send acknowledgement to:

Name

Street Address

City, State, Zip

Please list any additional acknowledgements that you would like to be sent and their addresses.

Please list who the tribute is from. If it is someone other than you, please provide their address.

Thank you for your contribution! An acknowledgment card will be sent to the recipient(s), if requested. You will receive a confirmation email that will serve as your acknowledgement and receipt of your contribution. Every gift counts, and we are grateful for your partnership in sustaining our financial future.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

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