Rising International Donation Form

Please print, fill out, and include this form with your donation.
Use the "Back" button on your browser to return to the Rising website.


Donation Amount:   * We can only accept donations in U.S. currency

$50 ________ $100 ________ $150 ________ $250 ________ $500 ________

$1,000 ________ $2,500 ________ $5,000________ Other_________

Recurring Every: Two Weeks _____Month _____Year _____ One-Time Only _____


Donation Method:

Check _____(enclose with this form) check or money order payable to ACTION Council/RISING. and mail to:
Rising International 300 Potrero Street Santa Cruz, CA 95060

Credit Card ____(please call Rising International at 831.429.RISE [7473] to donate by phone)


Quick Contact Info: Daytime Phone Number:______________________ email:__________________________

Credit Card Information

Type of card: ____ Visa ____Mastercard

Name on card: _______________________________

Card Number: ________________________________Card Expiration Date: _____________

Card Security Code: _______ (Usually the last 3-4 digits on the signature panel)

Billing Information for Card (all information must be exactly as it appears on your credit card statement)

Name as it Appears on Card: ____________________________________________

Address 1: ____________________________________________ Address 2: ______________________________

City: _________________________________State:__________Zip:______________ Country:________________

___Authorization Statement: "I authorize Rising International (via its fiscal sponsor, the Action Council)
to charge my credit card for the stated monthly donation amount each month. I understand that any
changes to this agreement must be made in writing".

___Authorization Statement: "I authorize Rising International (via its fiscal sponsor, the Action Council)
to charge my credit card for my one-time only gift".

Authorized Signature (x) ________________________________________________


In Honor Of: (if Applicable)

I'd like to make this donation ___ on behalf of ___ in memory of: ___________________________________

Please send acknowledgement of this donation to:  

First: _________________________________ Last: ________________________________________

Address 1: _____________________________________________ Address 2: ______________________________

City: _________________________________State:__________Zip:______________ Country:_________________

Anonymous Gifts:

We acknowledge all of our supporters by name in our annual report. However, you may
choose to make this donation anonymously. Check here ____ if you'd like to make this donation anonymously.

Thank you for your donation to Rising International!