Contribution Form

* Required Fields
SEND DONATION RECEIPT TO:

First Name  : 
Last Name  : 
ESA Member No.  : 
[As it apears on credit card. Treasurer's name if chapter donation]
Chapter / Council Name  : 
Chapter / Council No.  : 
This DONATION should be credited to:
an individual a chapter
Phone  : 
555 555-5555 (us) or 55 5555 5555 (au)
Fax  : 
E-Mail  : 
Address 1  : 
Address 2  : 
City  : 
Country  : 
State  : 
State/Province
(non US)
 : 
Postal Code  : 
DONATION IS TO BE APPLIED TO:

$25 - New Member Fee  : 
$15 - Annual Dues  : 
$500 - LIFE Active Membership  : 
"Fantasy" Event  :  $
"Foundation Event at IC Convention"  :  $
General Fund  :  $
Robert & Dixie Palmer Recognition  :  $
  In Honor of  : 
Stewardship Recognition  :  $
  In Honor of  : 
Send me information on the Planned Giving Program  : 
I have placed the ESA Foundation in my Will and/or Estate Plans  : 

MEMBERSHIP DUES FOR OTHER

Name of member dues are for  : 
ESA number of member dues are for  : 
$25 - New Member Fee  : 
$15 - Annual Dues  : 
$500 - LIFE Active Membership  : 
MY DONATION IS
A Memorial for  : 
In Honor of  : 


SCHOLARSHIPS AND GRANTS

ADAPT Grant $
LIFE Grant $
B. J. Clark Grant $
Outstanding Senior Youth Award Grant $

ENDOWMENTS

Alabama Past State Presidents Memorial Endowment $
Alaska State Council Endowment $
Alice And Jeanne Wagner Endowment $
Allen and Files Endowment $
Alpha Kappa #4401 / Amanda Reinke Endowment $
Alpha Kappa #4401 / Georgene Farr Endowment $
Alpha Kappa #4401 / Jean Hall Endowment $
Alpha Kappa #4401 / Jean Varga Endowment $
Alpha Kappa #4401 / Joann Zaleski Endowment $
Alpha Kappa #4401 / Michelle J. Doherty Endowment $
Alpha Kappa / Janet and Steve Gardocki Endowment $
Alpha Omicron #2520 Chapter Presidents’ Honorarium Endowment $
Alpha Omicron Arizona Endowment $
Alpha Upsilon #1884 Oregon Endowment $
Alyce J. Corbin Memorial Endowment $
Andy Davis Memorial Endowment $
Ann And Bob Becker Endowment $
Arizona Council Endowment $
Arizona Council Sunshine Fund Endowment $
Arkansas State Council Endowment $
Arlene And Dennis Schlosser Memorial Endowment $
Art and Sandy Fuller Endowment $
Ayers / Gallatin Endowment $
Barbara And Clayton Campbell Breast Cancer Endowment $
Barbara Stapleton Memorial Endowment $
Ben and Dot Hill Endowment $
Bernhardt Family Endowment $
Beta Chi Chapter Of ESA [Edmond, OK] Endowment $
Beta Zeta OK / Robert Glenn Rapp Foundation Endowment $
Betty Sanders Endowment $
Billy Brockmann Memorial Endowment $
BMW Hope Endowment $
Bob And Jan Jones Endowment $
Brenda And Wilbur West Endowment $
California State Council / Em Bullock Memorial Endowment $
California State Council Past Presidents' Auxiliary Endowment $
Carol Haas Endowment $
Carol Murphy Memorial Endowment $
Charles B. Atchison Jr. Endowment $
Charles Foy Jr. Endowment $
Charles Wilsterman Memorial Endowment $
Charline E. McCue Memorial Endowment $
Chuck Sabatino Memorial Endowment $
Colorado Lamplighters / Beta Omicron Endowment $
Colorado Lamplighters Endowment $
Cora E. And Royal L. Scott Family Endowment $
Court and Kim Mandrell Endowment $
Danzo And Elsie Shiramizu Endowment $
David P. Bogardus Memorial Endowment $
Deborah Humphrey Endowment $
Denton Family Honorarium Endowment $
Doris Morris Endowment $
Dorothy And Jim Meade Endowment $
Dorothy Dyer Vanek Endowment $
Dorothy Hendricks Endowment $
Dorothy Smith-Drumm Memorial Endowment $
Drs. Sidney and Corinne Milburn Memorial Endowment $
Eleanor Cannons Memorial Endowment $
Ellsworth Family Endowment $
Eloise Collins Endowment $
Elsie and Jay Vogler Memorial Teaching Endowment $
Emily Thomas Memorial Endowment $
Epsilon Eta / Linda Cronin Memorial Endowment $
ESA Foundation Endowment $
Floyd Gray Endowment $
Frances Kilgore Endowment $
Frances Shugart Endowment $
Gamma Chi #3668, Loveland, CO Endowment $
General Scholarship $
George W. Hill Memorial Endowment $
Georgia Men Of ESA Endowment $
Gordon And Betty Cape Continuing Education Endowment $
Harriette Dunckel Endowment $
Hawkins-Tuma Memorial Endowment $
Hazel Knapp Endowment $
Helen McSpadden Memorial Endowment $
Helen Pearson Memorial Edowment $
Helping Hands Of WSC Endowment $
Holsted / Simmons / Haymaker Endowment $
Hope Baney Memorial Endowment $
Hope for Kansas Heroes Endowment $
Illinois State Endowment $
Immanuel And Irene Schaan Memorial Endowment $
Indiana State Council Endowment $
Jack And Lucille Crossno Memorial Endowment $
Jacob And Barbara Wolf Memorial Endowment $
James And Betty Hartung Memorial Endowment $
James McPherson Memorial Endowment $
Jan And Pete Lee Family Endowment $
Jan Reppentine / Arkansas State Council Endowment $
Jane Matthews Memorial Endowment $
Jay Peckham Pharmacy Endowment $
Jeanne Parker Honorarium Endowment $
Jennifer (Jaegers) Wostal and Howard Thompson Memorial Endowment $
Jerry And Judith Huntley Endowment $
Jerry Harvey Endowment $
Joan G. Monson and Dean E. Monson Endowment $
Joe And Kendra Sabol Family Endowment $
Joe Jaegers Family Endowment $
Johnnie And Tom Moseley Memorial Endowment $
Johnson Family Endowment $
Jordan Griffith Memorial Endowment $
Joseph C. Eaheart Jr. Endowment $
Juanita Carter / Florida State Council Endowment $
Judy And Morton Lester Endowment $
Kafoury And McDougal Personal Injury Endowment $
Kansas Lamplighter Memorial Endowment $
Kansas State Council Endowment $
Kathy Quadrato Endowment $
Kay Mclaughlin Memorial Endowment $
Kay Mills Memorial Endowment $
Kenneth L Varns and Harvey D Varns Memorial Endowment $
Kentucky State Council Endowment $
Kristine Williamson Memorial Endowment $
Laverne “Bun” Young Endowment $
Laverne B. Woodard Endowment $
Leora Walton / Iowa State Council Endowment $
Les And Rosalee Echele Family Endowment $
Letha L. Scudder Memorial Endowment $
Linda Moore Endowment $
Lois E. Carter Memorial Teaching Endowment $
Lucille Eastin Memorial Endowment $
Lynn And Rich Hughes Family Endowment $
MARC Endowment $
MARC Purple Heart Endowment $
Margaret “Peggy” Rader Memorial Endowment $
Margaret Jesser Memorial Endowment $
Margene Holtze Memorial Endowment $
Marjorie J. Hamrick Memorial Endowment $
Marjorie Rushford Endowment $
Martha and Jim Beshears Endowment $
Martha Stickland Endowment $
Mary Louise Smith Memorial Endowment $
Maxine Wheelan / Delta Chi Endowment $
Maxine Wirth Graduate Studies Endowment $
McConnell Family Endowment $
Minnesota State Memorial Endowment $
Missouri GICC Endowment $
Missouri State Council Endowment $
Missouri Torchbearers’ Endowment $
Montana State ESA Endowment $
Myre Starr Honorarium Endowment $
Nancy Jo Fox Memorial Endowment $
Nebraska ESA Endowment $
Neta Hendricks Memorial Endowment $
New Mexico State Council Roadrunner Endowment $
Norma L. Moore Endowment $
Ohio State Council / Nancy Waymire Memorial Endowment $
Oklahoma Council District IV Endowment $
Oklahoma District II Endowment $
Olive Griffith Memorial Endowment $
Omicron - Tacoma, WA Endowment $
Oregon State Council Endowment $
Oscar And Joyce Whitewing Honorarium Endowment $
Parr Family Memorial Endowment $
Past International Council Presidents’ Endowment $
Pat Howard Memorial Endowment $
Pat Mallery For The Arts Memorial Endowment $
Peggy Jacques Memorial Endowment $
Phyllis Shoemaker Memorial Endowment $
Polk And Price Family Endowment $
Priscilla Gale Memorial Endowment $
Ralph And Letha Tarleton Endowment $
Ralph And Ruth Strother Endowment $
Ramona Paine-Means and Rod Means Endowment $
Raymond And Catherine Brizzolari Memorial Endowment $
Rho Chi #2988 – St. Charles, Missouri Endowment $
Robert Taylor Morelli / Gregory Gene George Memorial Endowment $
Rocky Mountain Regional Council Endowment $
Rodger And Rhea Weaver Catastrophic Disease Survivor Endowment $
Rodger And Rhea Weaver Endowment $
Rosagene Huggins Memorial Endowment $
Rosemary Stormant Memorial Endowment $
Ruth Gregg Memorial Endowment $
Sandy Kucera Endowment $
Sandy Weisenberger Endowment $
Second Chance Endowment $
SERC Endowment $
Serchettes Endowment $
Shalvay Family Endowment $
Sharon Petelle Specific Learning Disability Endowment $
Sherman And Nancy Reece Endowment $
Shirley A. Dreyer Memorial Endowment $
Sisters Of Georgia Memorial Endowment $
Snyder Mechanical Engineering Endowment $
South Dakota State Council Endowment $
St. Jude Children's Research Hospital Cancer Survivor Endowment $
Suzanne Jourdan Memorial Endowment $
Table Mountain Veterinary Clinic Endowment $
Texas ESA Clue Sisters Endowment $
Theta Zeta Fresh Start Endowment $
Tulsa Area Council Endowment $
Vi Gardner Memorial Endowment $
Virginia State Endowment $
Wallace And Margaret Shaw Memorial Endowment $
Washington State Endowment $
West Virginia Endowment $
Wilbur And Vivian Gibson Family Endowment $
Wilhelmina M. And Richard W. Herbin Endowment $
Willow C. Gray Endowment $
Winger Leyes Endowment $
Wisconsin Endowment $
Worda Russell Memorial Endowment $
York Family Endowment $
Zeta Chi Hot Springs Arkansas Endowment $
Zeta Jones Haldin Memorial Endowment $

ALL CONTRIBUTIONS ARE TAX DEDUCTIBLE

RECURRING PAYMENTS


Recurring payments are made on the first of every month. The first payment is transacted on the first of the current or upcoming month.
How many payments would you like to make?  

TURN AROUND CHECKS

The check you send to the TURN AROUND FUND must be made payable to ESA FOUNDATION. [Checks or donations must be for $ 25 or more.]

Amount Name of Charity EIN #
$
$
$
$
$
$

NOTES:


  1. All Turn Around checks to St. Jude Children's Research Hospital will be given directly to Headquarters for processing.
    If you would like it returned to you, please indicate that to us in writing.
    If you use ALSAC / St. Jude materials / supplies for your event, you may NOT use the Turn Around Fund.
  2. A Turn Around Check cannot be issued directly to an individual or reissued to a Chapter or State Council.
  3. The Internal Revenue Service does not allow the Foundation to use Turn Around funds for donations to the following:
    ESA Disaster Fund, State/Regional Love or Care Funds.
  4. All checks will be mailed to the donor / chapter for distribution to the charity, unless indicated otherwise.
  5. Checks that must be re-issued for whatever reason will have a service fee of $ 25 deducted from the check.
  6. Checks not cashed within 120 days of the date of issue will be considered a donation to the ESA Foundation General Fund.
  7. The name of the Charity must be listed as the IRS has them. If the EIN# is not provided your check will be returned.