Secret Santa Agency Enrollment Form

Thank you for your interest in the 2023 Secret Santa program. We are excited that you have chosen to participate this year. We assure you we are here to help you meet the need of those you serve in our community. Although we are open to serve all, this year we will prioritize children, seniors, veterans and the disabled. Your health and safety, as well as that of our staff and volunteers, is our top priority and we will keep you updated with adjustments to the program as they become finalized.

Donation Amount:

$ 150.00

I'd like to help cover the transaction fees of 0 for my donation.

Agency Name:

Select Payment Method

Check
Credit Card

Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

Email Address *

Credit Card Info

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Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $150.00