Ride4UnitedWay Donation Form - United Way of Durham Region

Would you like to share your gift amount on the fundraising honor roll? Yes, please display the amount of my donation publicly on the fundraising honor roll.

Personal Note (only visible to the fundraising participant):

Yes, this is an honour or memorial gift.

Honour Gift Type:

Honouree First Name:

Honouree Last Name:

Would you like to send an email notification? Yes, I would like to send an email notification.

Your First Name:

Your Last Name:

Send email notification on:Select month of credit card Select Expiration Year

Recipient email addresses (separated by commas):

Layout(s):

Subject Line:

Personal Message:

Yes, please send me a copy of this email notification.

Title:

First Name:

Middle Name:

Last Name:

Suffix:

Street 1:

Street 2:

City:

Province/State:

Postal Code/ZIP:

Country:

Email Address:

Yes, I would like to receive communications from United Way of Durham Region.

Remember Me

Yes, I want 100% to go to United Way of Durham Region. Please increase my amount by 3% to cover all credit card transaction fees.

You are currently making a general event gift to the Ride4UnitedWay 2022 event.

Gift Information

Honour/Memorial Information

Billing Information

Payment Information

Credit Card Information: