Online Giving Form

Thank you for your continued support

*First Name:
* Last Name:
Company Name: (if applicable)
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Country:
* Primary Phone:
* Email:
An email confirmation will be sent to this address when your gift has been submitted on-line.

AFFILIATION
Check all that apply

Current School Parent	Youngest or Only Student Name:
Past School Parent	Youngest or Only Student Name:
Grandparent	Youngest or Only Student Name:
Alumni	Class Year:
Board Member
Staff
Friend of the School
Other	Please Specify:

GIVING OPPORTUNITIES

Annual Fund - View Recognition Levels for Annual Fund

Endowed Fund - MDS Financial Aid Scholarship Fund

Endowed Fund - Scott Robert Halkett Memorial Fund

Other Gift:

For gifts in memory of or in honor of, please mail an acknowledgement letter on my behalf to the follow person:

Full Name
Address
City, State, Zip Code
Primary Phone
Email
Additional comments and/or special directions for donor recognition:
* Do you wish your name listed in our donor reporting and publications? Yes No
My company will match my gift If your gift will be matched, please enter the Matching Gift Organization name below, and send your matching gift form to: Mizzentop Day School, 64 East Main Street, Pawling, NY 12564. Matching Gift Organization Name:

CONTRIBUTION PAYMENT INFORMATION

Your payment will be charged/debited as received and any remaining recurring payments will be charged/debited on the 15th of the month. This transaction will appear on your credit card statement in the name of Mizzentop Day School. For your security, we have ensured that this form meets all of the Payment Card Industry Data Security Standards (PCI-DSS).

* Gift Type
One Time Gift
*Gift Amount:

Recurring Gift Total pledge amount should be paid between today and June 30, 2013. Thank you.
* Monthly Charge Amount:
Your first payment will be debited today and future monthly charges will be made around mid month.
* Number of Payments: