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 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 o 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 2019 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 Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.