Memorials and Honorariums ~ Alzheimer and Parkinson Association of Indian River County

Memorials and Honorariums

This type of gift is made in memory of a deceased family member, friend, neighbor, colleague, etc., often in lieu of flowers for a funeral service, an anniversary of the individual's passing or other special times of remembrance.

$ Donation Amount:

Personal Info

First Name *

Last Name

Email Address *

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Phone *

In Memory of

In Honor of

Please mail notification of gift.

Recipient of Gift Notification Letter

Name

Address

City

State

Zip Code

A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING (800) 435-7352, TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE CH18787.

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Donation Total: $25