RogersFdn

Rogers Behavioral Health Foundation Logo

LimeLight Gift

Yes! I would like to honor a Rogers staff member who made a difference for me.

The person I would like to place in the LimeLight is:

Name (first and last)*

Treatment Program Name

Level of Care

Treatment Location

What makes this person special? (optional)

255 character limit

0 / 255

I understand that comments made in the box above will be shared with my LimeLight recipient.

Do you approve of sharing your name with your LimeLight recipient?

Acknowledge me as:

Gift amount

The gift amount will always remain confidential.

Donor Information

First Name

Last Name

Mobile Number

Address

City

State

Zip

How would you like to pay?

This is a secure 256-bit SSL encrypted payment

Card Number

Expiration Date

CVV

Yes! I would like to cover the 2.59% payment processing fee.

Additional permission

Do you give Rogers permission to share your comments (only) in digital and/or print communications for external marketing, fundraising or awareness purposes? Your name will remain confidential.

Electronic Signature

Typing your name below serves as your electronic signature and signifies your consent to use the content provided as designated.