$40K Community Challenge Registration Form

 Legacy ($2,500) Royal ($1,000 - $2,499) Platinum ($500 - $999 Gold ($250 - $499) Silver ($150 - $249) Bronze ($1 - $149) Our Youngest Supporters (Under Age 15): $1

Donation Amount $

 I would like to volunteer. Please send me more information. I would like to attend a tour of La Casa

Name (as you wish to be listed) *

 I would like to remain anonymous.

Address

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Phone

Email *

 I pledge that a check made out to La Casa de Don Pedro will be mailed to: 75 Park Avenue, Newark, NJ 07104 Online payment was made via Paypal or Just Give.

You can access our Paypal and Just Give accounts here.

You can also make a gift to La Casa in memory of someone special or in honor of a holiday, birthday, or anniversary.
Please provide us with the following information and La Casa will send a card recognizing your gift.

Special Occasion

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Recipients Address

City, State, and Zip