Fund A Cure

Fields marked * require an entry.

Untitled Document

Package Name	Amount	Subtotal

$25,000 Fund A Cure	$25,000.00	$0.00



$15,000 Fund A Cure	$15,000.00	$0.00



$10,000 Fund A Cure	$10,000.00	$0.00



$5,000 Fund A Cure	$5,000.00	$0.00



$2,500 Fund A Cure	$2,500.00	$0.00



$1,000 Fund A Cure	$1,000.00	$0.00



$500 Fund A Cure	$500.00	$0.00



$250 Fund A Cure	$250.00	$0.00



$125 Fund A Cure	$125.00	$0.00

Yes, I would like to contribute to Fund A Cure.

Amount:

Total:

$0.00

As a convenience, you may pre-register a credit card on the submission page to charge your purchases at event 2014 JDRF Gala.

I authorize JDRF - Virginia Chapter - 4692 to use the credit card entered on the submission page at event 2014 JDRF Gala. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.

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