Donations Test

First Name *

Last Name *

Spouse First Name

Spouse Last Name

Phone Number *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Gift Amount *

USD

Where to useAnnual Fund (Not Designated)

Annual Fund (Designated Gift - enter Department)

General Fund (Not Designated)

General Fund (Designated Gift - enter department)

20/20 Vision Endowment Fund

Memorial Gift in honor of

1130 South 19th Street • Harrisburg, PA 17104 • Phone: 717-238-2531 • Fax: 717-238-0710 • info@vrocp.org