Giving Statement Request Form

When completing this form you are requesting a copy of your giving statement from the previous year.

Name:*
First (MI) Last
Are You a Member?*
- Yes
- No
Membership No.:*
Payroll Deduction:*
- Yes
- No
Address:*
Street Address Address Line 2 City State ZIP Code
Primary Contact Number:*
Home Phone:
Choose how you would like to receive your giving statement:*
- By postal mail
- By email
Email:*
Enter Email Confirm Email
Consent:*
I certify that I am the member signing and requesting this information. The signature provided is my own.
Signature:*
Use your mouse or touch screen to complete the signature section.
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Email
This field is for validation purposes and should be left unchanged.

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