KAYAKING FOR A CURE

NOTE: Please fill out "Tribute Type" & "Tribute Name" ONLY if you are making your donation in honor or memory of an individual. You may provide information regarding who you would like notified of your gift & where the correspondence should be mailed (i.e. email address or physical address) in the "Additional Comments" section below.

Tribute Name

Gift Information

Donation Amount*
  • $50
  • $100
  • $250
  • $500
  • $1000
  • Other $

Contact Information

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

*While these fields are required, we commit to you that we will not share or sell your email address, phone number, or any other personal information with anyone! Our intent is simply to send you updates periodically about SebastianStrong. Your donation confirmation wiill also be sent by email. 

Payment Information

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

Security Code

Share This Form

Powered by eTapestry.