Donation/Order Form

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Contact Information

First Name *

Last Name *

Email *

Phone Number *

Street Address *

Street Address #2

City *

State/Province *

Postal Code *

Country *

Please Select from Our Donation Options *

General Contribution

Drawing / Special Events

Memorials / Tributes

Endowments

General Contribution

Donation Amount *

Drawing / Special Event

Drawing / Special Event Type *

Hawaii Trip

Amazon Raffle

Amazon Gift Card Raffle ($10/ticket) *

Amazon Raffle Bulk Tickets (3 for $25) *

Conference Registration / Hotel Drawing Single Ticket ($10/ticket) *

Conference Registration / Hotel Drawing Bulk Tickets (3 for $25) *

Hawaii Trip Single Tickets ($20/ticket) *

Hawaii Trip Bulk Tickets (3 for $50) *

Total Drawing / Special Event $

Total Value of All Drawing / Special Event Donations

Memorials / Tributes

Memorials / Tributes Type *

Memorial

Honor a Mentor

Other Tribute

Memorial Honoree Information

Donation Amount *

Honoree Name *

Family Member(s) for notification

Email (if known)

Honoree Mailing Address

Street Address *

Address Line 2

City *

State/Province *

Postal Code *

Country *

Honor a Mentor Honoree Information

Donation Amount *

Honorees Name *

Honoree Email *

Honoree Mailing Address

Street Address *

Address Line 2

City *

State/Province *

Postal Code *

Other Tribute Honoree Information

Donation Amount *

Honorees Name *

Honoree Email *

Honoree Mailing Address

Street Address *

Address Line 2

City *

State/Province *

Postal Code *

Total Memorial Donations

Restricted Endowments

Please enter the amount you would like to donate to each fund.

A. Fleming Bell Education Fund Amount * $

American Legal Publishing Corporation Education Fund Amount * $

Anne Uecker Education Fund Amount * $

Arizona Municipal Clerks Association * $

Barstow Family Education Fund Amount * $

Business Records Corporation Education Fund Amount * $

Region IX Education Fund * $

Charles & Stephanie Kelly Endowment Fund Amount * $

Chris & Patrick Wilder Education Fund Amount * $

City Clerks' of California Scholarship Fund (CA Clerks only) Amount * $

Charlie Buttiglieri Education Fund Amount * $

Coded Systems Education Fund Amount * $

Donna Young Education Fund Amount * $

Dyanne Reese Education Fund Amount * $

Elizabeth Kiss Education Fund Amount * $

General Code Education Fund Amount * $

Granicus Education Fund Amount * $

iCompass Education Fund Amount * $

James B. Tinnin Education Fund Amount * $

Kayser Education Fund Amount * $

Laserfiche (Institute Directors Colloquium) Amount * $

Lyall Schwarzkopf Education Fund Amount * $

Marianne Edwards Education Fund Amount * $

Mary Johnston Education Endowment Amount * $

Mary Lynne Stratta Education Fund Amount * $

MCCi Municipal Clerk Education Fund * $

Microvote, Inc. Education Fund Amount * $

MMCCA Mary Ann Hess Fund * $

Municipal Clerks of New Jersey Education Fund Amount * $

Municipal Code Corporation Education Fund Amount * $

Muriel Rickard Education Fund * $

Nebraska Education Fund (NE Clerks only) Amount * $

New Mexico Municipal Clerks Education Fund (NM Clerks only) Amount * $

Norma Rodriguez Education Fund Amount * $

OAMR Education Fund (Oregon Clerks only) Amount * $

Pamela Smith Scholarship Fund * $

Region IV Education Fund (AR, LA, MS, OK, TX) Amount * $

Reynolds Miel Education Fund Amount * $

Robert T. Thorpe Scholarship Fund Amount * $

Robert W. Pritchard Education Fund Amount * $

Sharon Cassler Education Fund * $

Sheri Pierce EPP Education Endowment * $

Simmons Leadership Scholarship Fund Amount * $

Stephen & Karen Wolf Scholarship Fund * $

Tak & Helen Kawagoe Education Fund Amount * $

Tom Spengler Endowed Scholarship Fund * $

Washington Municipal Clerks Association * $

Wyoming Association of Municipal Clerks & Treasurers * $

Total Restricted Endowments Donations $