LCIF Pledge Form

I pledge a total contribution to LCIF of US$.*

Pledge must be a minimum of US$5,000

My first payment will be US$*

My first payment date will be by*

Payment Frequency*

MonthlyAnnually

Enter Monthly Amount

Enter Yearly Amount

Payment Method*

Credit Card/PayPal*CheckWire Transfer

*Please submit your online donation at lionsclubs.org/donate.

Pledges equal to or greater than US$25,000 are payable over five years; Pledges of US$5,000 or more are payable over three years, unless otherwise requested by the donor. If no payment frequency is selected, the Foundation assumes equal annual installments based on pledge amount. Visit lcif.org/donate to make your gift online and to learn about other ways to give.

For pledge recognition and recording purposes, please provide the following information:

Name*

Address*

City*

State/Province*

Zip/Postal Code*

Country*

Email*

Phone*

Member ID

Club Name

District Name

Choose if anonymous gift

Please keep my personal information anonymous. By selecting this box, I understand that my club or district (if any) may still receive recognition for my gift.

If above box is not selected, your name, district (if applicable), and donation range will be listed online here

Consent acknowledgement*

I hereby consent to sharing the above information with LCIF for purposes of this pledge, and further acknowledge that I have read and agree to comply with LCI’s Privacy Policy and Terms of Use.

If above box is selected, I further acknowledge that I have read and agree to comply with LCI’s Privacy Policy and Terms of Use.

LCI and LCIF are Equal Opportunity Providers. Lions Clubs International Foundation (LCIF) is a 501(c)(3) tax-exempt charitable organization.

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LCIF Pledge Form

PLEDGE INFORMATION

DONOR INFORMATION