Pachyderm

Members between 40-49 years old can join at a Junior Pachyderm, and members under 39 years old can join as a J-Pach. (Women only).

Who's donating

First Name

Last Name

Country

Address

City

Postal code

Phone

Send email updates

Employer

Occupation

Employer Country

Employer Address

Employer City

State

Postal code

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are not tax deductible.

Amount

$1,000.00

I want to pay this in installments

Credit card number

Expires

Security code (on back)

Contribution rules • I affirm that I am making this contribution via my personal credit or debit card for which I have a legal obligation to pay, and not through a corporate or business entity card or the card of another person. • My contribution is made from personal funds, and not from the general treasury funds of a corporation, organization or national bank. • I have not received any funds from another person or entity for the purposes of making this contribution. • I am a United States citizen, or a Green Card Holder who has been lawfully admitted for permanent residence and this contribution will not be reimbursed by another person.

I confirm that the above statements are true and accurate.