Donation Information

Please complete the form below and click on "Submit" to make your tax-deductible donation.

To submit this form, all "*" fields must be filled in.

$100

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Other $

Salutation

First Name*

Last Name*

Address*

City*

State*

Zip*

Phone*

Email*

Confirm Email*

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Card Type*

Card Number*

Expiration Month*

Expiration Year*

Card Security Code*

Acknowledgement

For all donations, please list your name(s) as you would like it to appear in our program listings (separated by commas)

Name(s) to acknowledge

I would like this donation to remain anonymous

Dedication Information (Optional)

Dedication Type

Dedication Honoree Name

Personal note to be included with donation

Dedication Acknowledgment Information

Acknowledge by

First Name

Last Name

Address

Other Ways to Give

Make a Recurring Donation

Give by Phone

You can make a gift by calling:
336.725.1904

Give by Mail
You can also give by printing this form and mailing to:
SECCA
750 Marguerite Drive
Winston-Salem, NC 27106