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Name*
First Last
Email*
How did you find out about us?*
- I visited Ariel
- I read about Ariel in the news
- I follow your page on social media
- A friend referred me to you
Please write the name of the friend who referred you to us.

Your Donation
Yes! I'd like to support Ariel today.*
- I'd like to make a general donation.
- I'd like to support a specific project.
Please choose the specific project that you would like to support.
One-time or monthly donation amount (USD)*
I want to make a recurring donation
- Yes
For recurring donations, please continue to charge my card for a period of:
- One Year - 12 months
- Two Years - 24 months
- Three Years - 36 months
Dedication
Would you like to make a dedication?
- Yes
Please indicate what sort of dedication you would like to make:
Please include any details associated with your dedication (i.e. name of honoree, occasion, etc.):
Comments

Billing information
How would you like to pay?*
- Credit Card
- Check
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Phone Number
Credit Card Information
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Check
Check payments should be mailed to: American Friends of Ariel PO Box 880714 Boca Raton, FL 33488 U.S.A.
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