Autism on the Seas

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Gluten/Cassien Free Diets Accommodated

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Fundraising Donation Form

You may make a Donation in two ways:

1. ONLINE FORM

Complete and submit the form below.

2. CALL US

You may call us to donate at 1-800-516-5247.

Method of payments accepted:

- All Major Credit Cards
- Debit Cards
- Checks

After you complete the form below, we will:

- Process your payment to the Cruise Fund of your choice,
- Send you a receipt and,
- Forward your donation pledge (if you choose) to the family of your choice.

DONOR CONTACT INFORMATION
This is the person/organization who is making the donation

First Name
Last Name
Company Name
Address
Address (cont)
City
State
Zip Code
Email (Required):

Cruise Fund
Please choose one fund per form

"Joshuah Gilman" Fund

Donations accepted until: March 31, 2010

Donation
Please enter the amount of your donation:
$ .

I would like the family to know the donation came from us.
Please keep us as an anonymous donor.

I give permission to share my my email address with the family

Feel free to use this section to send a message to the family

Donation Method
Choose your method of payment (Credit Card or Check)

CREDIT/DEBIT CARD

Card Type

Visa MasterCard Amex Discover

Card Number

Expiration Date

Verification Code (on back of Card)

Visa/Mcard 3-Digit Amex 4-Digit

Name on Credit Card:

Billing Address

Street

City, State

Zip Code

Phone

CHECK

Make check payable to
"Alumni Cruises"

Please ensure you reference the Family Fund name

Send payment to
Alumni Cruises
ATTN: Billing
15 Oak Glen Drive
Shelton, CT 06484

“Autism on the Seas” is a division of Alumni Cruises, LLC
1-800-516-5247 info@alumnicruises.org