Pay respect to someone who has passed away by making a gift to Family Counseling Services in their memory. Celebrate the life of a family member, friend, staff member or colleague by making a gift in their honor or to celebrate an anniversary, graduation or other special occasion. 

 

Gift Information

Donation Amount*
  • $25
  • $50
  • $100
  • $250
  • $500
  • Other $

Tribute Information

Who would you like to honor?

First Name*
Middle Name
Last Name*

Who would you like to receive the acknowledge? Family Counseling Services will process a personal note acknowledging your gift, to the person(s) of your choice. 

Acknowledgement Name
Acknowledgement Email
Street Address
Street Address Line 2
City
State
ZIP Code

Your Name on Acknowledgement

Please tell us how you would like your name to appear on the acknowledgement and create a personalized message if you choose.

Acknowledgement "From" Name
Acknowledgement Personalized Message

Donor Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code