A Memorial Gift to Prevent Blindness offers you a thoughtful and caring way to remember a loved one while contributing to our mission of preventing blindness and preserving sight.
 
Once we process your gift information you will receive an acknowledgement email and the next of kin you've selected will receive a card notifying them that you have made a gift in memory of their loved on (we do not disclose the amount of the gift).

Supporting In Memory Of

Your Donation

Donation Option*

One-Time Monthly

per month

Donation Amount*

Maximum Amount to Donate (Optional)

$ Total

In Memory of - First Name*

In Memory of - Last Name*

Next of Kin - First Name

Next of Kin - Last Name

Next of Kin - Address

Next of Kin - City

Next of Kin - State

Next of Kin - Zip

Your name as you would like it to appear on the card sent to next of kin*

Corporate Giving

Individual Gift Gift on behalf of my company

Employer Name

Company Name

Payment

Payment Method*

{accountType} ending in {accountLastFour}

{accountType} ending in {accountLastFour}

Choose a different way to pay

Contact Details

 

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Name*

First Name

Last Name

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Email Address*

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