NYWEA Scholarship Program Donation - Yes, I'm interested in Giving!

Contact Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• Company
• * Address 1:
• Address 2:
• * City:
• State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• ZIP Code:
• Phone:
• Cell Phone:

• Check One:

  • Home Address
  • Work Address

• Fee

  Type	Fee
  $100 New 5 Year Contribution Amount	$20.00
  $250 New 5 Year Contribution Amount	$50.00
  $500 New 5 Year Contribution Amount	$100.00
  $1,000 New Pledge Amount	$200.00
  $2,500 New Pledge Amount	$500.00
  $5,000 New Pledge Amount	$1,000.00
  $10,000 New Pledge Amount	$2,000.00
  $20,000 New Pledge Amount	$4,000.00
  $10 One-Time Contribution	$10.00
  $25 One-Time Contribution	$25.00
  $1,500 - One-Time Payment or Payment on Previous Pledge	$1,500.00
  $1,000 -One-Time Payment or payment on previous pledge	$1,000.00
  $500 - One-Time Payment or payment on previous pledge	$500.00
  $250 - One-Time Payment or payment on previous contribution	$250.00
  $200 - One Time Payment or payment on previous contribution	$200.00
  $125 - One Time Payment or payment on previous contribution	$125.00
  $100 - One-Time Payment or payment on previous contribution	$100.00
  $50 - One-Time Payment or payment on previous contribution	$50.00
  $20 - One-Time Payment or payment on previous contribution	$20.00

• * Chapter: --Choose-- Capital Central Genesee Long Island Lower Hudson Metropolitan Western Other
• Notes/Comments:

• If paying by credit card, your Zip Code mailing address must match credit card mailing address. Paypal account not required.

• *

  Please indicate if Corporate or Individual

  • Corporate
  • Individual