Make your pledge today.
Please fill out this form to make your pledge. We will then set this up in our system to be paid in the way that you mark on this form. Thank you for your support!
Email address *
First and Last Name *
Mailing Address *
Phone *
My Total Pledge Amount $ *
Check how often you would like to pay this pledge amount. (your total amount is broken down into increments based on your selection; for example, if your total pledge is $120 and you select monthly, your payments will be $10 a month for 12 months unless otherwise specified) *
How would you like to pay your pledge? *
Did a volunteer or staff member encourage you to make this donation? Please type their name here if applicable. If not, please type n/a. *
Please type your name as you would like to be recognized on our donor board. *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Rocky Mount Family YMCA. Report Abuse