Monthly Donation Club

By selecting one of the following amounts you allow CNF to debit your credit card for that amount each month. If at anytime you would like to discontinue your monthly contribution, please contact Alanna Peer at apeer@childneurologyfoundation.org. Thank you for your generosity.

Instructions:

To make a donation, please fill out the form below. Once you have completed the form, please click the "SUBMIT" button to complete the donation process.

 
  Choose Amount
 
$25 Per Month for 1 Fiscal Year
$50 Per Month for 1 Fiscal Year
$100 Per Month for 1 Fiscal Year
$ Per Month for 1 Fiscal Year


  
  Donor First Name
 
  Donor Last Name
 
  Address
 
 
City State   Zip
 

 
  Home Phone
  — —

  Work Phone
  — —

  E-Mail
 


  Payment Info:
 
  Credit Card Number
 
  
  Card Expiration
  
  Month    Year 

  
 
This gift is a tribute in honor of:
 

 
This gift is a memorial in honor of:
 

  Please send tribute or memorial acknowledgment to:
 

  at this address
 
 
 


The Child Neurology Foundation is a tax-exempt 501 (c)(3) organization; all donations are tax-deductable under limits of current law.
 






Child Neurology Foundation
2000 West 98th Street
Bloomington, MN 55431

Local: (952) 641-6100
Toll Free: 1-877-236-5430 (1-877-CNF-KID0)
Email: jstone@childneurologyfoundation.org