	Developmental Disabilities Children - Support

•	Stefanie Rose Rieger Memorial Fund
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Stefanie Rose Rieger Memorial Fund

If you wish to make a donation to the Stefanie Rose Rieger Memorial Fund at Variety Child Learning Center, please select a gift amount below.

For information or questions, please contact Jacqueline Duodu at 516.921.7171 Ext. 2259.

STEP 1: CHOOSE THE NUMBER OF TICKETS

Qty	Cost		Total
	x $125	$

Seating Requests or Notes

STEP 1: ENTER YOUR GIFT AMOUNT

Donation Amount

STEP 3: REVIEW TOTALS

$		Tickets
$		Donation

$		Grand Total

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
Please enter security code as showing:

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