Donor Information
First Name
Last Name
Billing Address:
City:
State:
Zip:
Phone Number:
Email Address:
Donation Amount
I would like to make a donation in the amount of:
$1000
$500
$250
$100
Other Amount:
Please display my name on the participant's public donor wall as:
Please do not display my name on the donor wall.
Participant Information
Event NameWoman of Impact Triangle NC Spring 2023
Event ID8875
Participant ID24600971
Participant NameLeah Kelly
Team NameLeah Kelly
Team ID
Mailing Information
Please send this completed form with checks to: