	Developmental Disabilities Children - Support

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Make A Memorial Donation

To make a gift to VCLC online, please enter your information below, or by phone, call our development department at 516.921.7171, Extension 2259 or Extension 2144; or by mail, VCLC, 47 Humphrey Drive, Syosset, NY 11791, Attention J. Duodu. Thank you. Make an investment in our children, our most precious gift. You may make a contribution to honor a lost loved one. This is a gift that represents a heartfelt gesture while enhancing the programs for children at VCLC.

STEP 1: CHOOSE YOUR GIFT AMOUNT

		$15
		$25
		$50
		$100
		$500
		$1000
		Other Amount $.00

STEP 2: PAYMENT INFORMATION

(required fields are in red)

Credit Card Type
Card Number
Card Code (CVV)	Where is the CVV?
Expiration Date

STEP 3: CONTACT INFORMATION

(required fields are in red)

First Name
Last Name
Address 1
Address 2
City
State	(U.S. Residents ONLY)
Postal / Zip Code
Country
E-mail Address
Telephone	Numbers only; no spaces
Phone Extension

Yes, sign me up for the VCLC eNewsletter.

STEP 4: MEMORIAL INFORMATION

This gift is in memory of:

Mail a card on my behalf to the following person:
First Name
Last Name
Address 1
Address 2
City
State	(U.S. Residents ONLY)
Postal / Zip Code
Country
E-mail Address
Telephone
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I prefer my donation to be anonymous.

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Make an investment in our children... Our most precious gift!