Online Donation

Dietert Center

Helping others can always make you smile.
Please fill in all information that applies to the donation you are making.
Full Name *
Address *

Street Address

Street Address Line 2

City State

Zip Code
E-mail *
Phone Number *

Area Code Phone Number
Donation *

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USD Description
One time gift or monthly donation? *
Please specify what Dietert Center Program you wish to benefit: *

Greatest Need Nutrition/Meals on Wheels Take 5 Club Dementia Care Advocates Medical Equipment Lending Handyman Service Club Ed Buy a Brick ($50 each)
Brick Message: Enter the message EXACTLY as it will appear on the brick, up to 3 lines/12 characters per line including blank spaces and puncuation.
Line 1
Line 2
Line 3
What better way to honor or remember someone than to make a gift that supports the vital needs of our community?
My donation is in honor of:
My donation is in memory of:
Would you prefer that we notify someone about your gift? (Amount will not be disclosed)

Yes
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
If you would like to add a personal message on our notification, please type here (Space limited to 250 characters)
Any additional information you would like to share
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Dietert Center