One-Time Gift Form
Monumental Wellness Retreat · 501(c)(3) nonprofit · Tax ID: 93-1624007
Date
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Month
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Day
Year
Date
Name: Please enter your full legal name for donation acknowledgment and tax purposes
*
First Name
Last Name
Email
*
We’ll send your donation receipt here and keep you updated on how your gift makes a difference
Phone Number
*
Please enter a valid phone number. Just in case we need to follow up or thank you personally
Format: (000) 000-0000.
Would you kindly provide us with a photo of you to use in our marketing materials?
Yes
No
Upload/Take My Photo
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If you’d like to be featured in our newsletters or event materials, you can upload a photo here or take one directly from your device.
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Photo Permission :If you provided us with your photo, you give Monumental Wellness Retreat permission to use it in promotional materials (social, web, print). Your photo is never sold or shared outside Monumental Wellness Retreat. Initials
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How did you hear about us?
*
A friend or family member
Social media
Event or fundraiser
Another organization
Therapist or coach
Med spa or wellness provider
Google search
Other
Who can we thank?
Full name of person who introduced you to us
Address: Optional but recommended for year-end summaries. If you’d like to receive a physical year-end summary or thank-you note, please enter your mailing address.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How would you like your donation to be used?
*
General Fund (use where it’s most needed)
Specific Project/Event
Split my donation between multiple areas
I am sponsoring a service today
Other
Name of Service
Name of Project/Event (s)
How would you like to split your donation between multiple areas?
Would you like to let us know if someone you care about is experiencing or has experienced abuse?
Yes
No
Name of Person(s)
Completely optional. We hold space for the people you carry in your heart. We’ll hold them in mind—even if you never share their name.
Cash Donation Gift?
Yes
Received By:
On-Line Donation Gift
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