Name *
Title
First Name
Last Name
Suffix
Email *
Phone *
Address *
Address Line 1
Address Line 2
City
State
Zip
Donation Amount *  
$
Designate Your Gift *
Employer
Does your company match gifts by employees to non-profits? See below for more about corporate matching gifts.
How did you hear about IILA? *  
If you selected "Other," please specify in the "Note" section below.
Note  
 I'd like to add 3% to cover the card processing fee so that IILA receives 100% of my contribution.