General Campaign Donation

2021 Walk for Alzheimer's - ROCKETS AND RE-ENTRY
Thursday, June 24, 2021

This Form makes a General Campaign Donation to this campaign ONLY!
If you want to donate in support of a particular Team or Participant then click CANCEL.
* Required
Gift Information
* Select A Gift Amount  
  Enter a different amount ?
  Yes, you can display the amount of my donation publicly.
Donor Information
  Display Name: First and Last Name      Company Name
* First Name:
  Middle Name:
* Last Name:  Please enter exactly as it appears on your card.
* Company Name:
* Email Address: ?
    Yes, I would like to receive communications from ADRC.

* Billing Address 1:  Address Line must match the address on file for your credit card.
  Billing Address 2: ?
* City:
* State / Province:
* ZIP / Postal Code: ?
* Country:
  Donor Phone Number: ?
  Remember someone special with a donation in their honor or memory
In Honor of: In Memory of:
  Your Tribute's Name, as you would like it to appear publicly:

* Credit Card:
American express
* Card Number:
* Verification Code:
For your safety and security, we require that
you enter your card's verification number.
* Expiration:

Security Image:
 Get a new challenge
Security Code:



Alzheimer's Disease Resource Center
Office: 631.580.5100
Connect with us:  Facebook    LinkedIn    Google+    Twitter    Instagram 

200 Carleton Avenue
East Islip, NY 11730

Satellite Office(s):
By Appointment ONLY

33 Flying Point Road, Suite 122, Southampton, NY 11968
100 Quentin Roosevelt Boulevard, #102, Garden City, NY 11530
3 Dakota Drive, Suite 300, Lake Success, NY 11020

Alzheimer's Disease Resource Center, Inc. (ADRC) is a not-for-profit 501(c)(3) tax exempt organization.
©1994 - 2022 Alzheimer's Disease Resource Center. All rights reserved.
Site Developed and Hosted by   ITI Computers   International Technical Industries, Inc.
Copyright 1994 - 2022 : ALL RIGHTS RESERVED