Annual Appeal Donation Recognition Levels Founder’s Circle$5,000 & above Director’s Circle$2,500 – $4,999 Leader’s Circle$1,000 – $2,499 Partner$500 – $999 Patron$250 – $499 Sustainer$100 – $249 Supporter$1 – 99 Donation Form Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Per New York State law, online donations can only be accepted from New York State residents. For out-of-state donations, please contact Preston Evans, Vice President Development & Donor Relations, at pevans@achieveny.org.Email I / We would like to make a donation that will be used to benefit individuals with intellectual, developmental and other disabilities in the amount of Donation Type*One TimeRecurring (monthly)This gift is in memory of:This gift is in honor of:Please send an acknowledgment card to:Other I would like information on how to remember ACHIEVE in my will or to give to the endowment. I would like information about ACHIEVE and opportunities of giving and service. I would like a tour. I would like a presentation to my church or club. Your gift to the 2023 Annual Appeal automatically renews your membership with ACHIEVE, allowing us to continue to advocate for individuals with intellectual, developmental and other disabilities. If you would prefer to opt-out of being a member of our organization, please check the box. Yes Per New York State law, online donations can only be accepted from New York State residents. For out-of-state donations, please contact Preston Evans, Vice President Development & Donor Relations, at pevans@achieveny.org.Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Δ Upon request, a copy of the latest annual report can be obtained from the organization, or from the Office of the Attorney General, by writing the Charities Bureau, 120 Broadway, New York, NY 10271