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Donor Pledge Form
Be a Centennial Year Sponsor of Our Lady's Shrine! This form will record your pledge to the Centennial Sponsor Drive.
Please note: Pledges must be fulfilled by May 31, 2024.
Questions? Contact Mary Lee Harris at 504.473.6750 or shrineolps@gmail.com.
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Email
*
Your email
Gift Amount
*
$15,000
$10,000
$5,000
$2,500
$1,000
$500
Other:
Payment Options
*
One-Time Gift
Equal Installments
Installment Reminders
*To be fulfilled by May 31, 2024
Weekly
Monthly
Quarterly
Semi-Annually
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Donor Information
Donor's Full Name
*
Your answer
Recognition
*
Please list my full name for recognition.
I want to remain anonymous.
This gift is in memory of someone.
This gift is in honor of someone.
Name for Recognition
Your answer
Billing Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Daytime Phone Number
*
Your answer
Matching Gifts
Will your donation be matched by you or your spouse's employer/company?
Yes
Company for Matching Gift
Your answer
Pledge Form Acknowledgement
*
I have reviewed the information contained in this form and would like to make my pledge to Our Lady's Shrine. I consent to receive reminders by email according to my fulfillment terms.
Required
Special Instructions
Your answer
The National Votive Shrine of Our Lady of Prompt Succor is a 501(c)(3) non-profit institution. EIN #: 32-0295257
A copy of your responses will be emailed to the address you provided.
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