Donation Form

Thank you for supporting Second Sense. You can make your donation by completing this form, printing it and sending it in with your check or credit card information to:

Cheryl Megurdichian
Director of Development
Second Sense’65 E. Wacker Place, Suite 1010
Chicago, IL 60601

Donation Form

A printable form to make a donation by mail

I want to help people with vision loss live independent, active lives. Enclosed is my donation of:*
- $25,00
- $50.00
- $100.00
- $250.00
Payment Method
- Enclosed is my check made payable to Second Sense
- Please charge my Credit Card using the information provided below
Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email
Tribute Gift
To make a donation in honor of memory of a loved one, please fill out the remainder of this form.
- Gift made in memory of
- Gift made in honor of
Tribute name
Tribute Occasion (if applicable)

Is the gift in honor of someone's birthday, anniversary, in lieu of a wedding gift, etc.
Name
If you would like Second Sense to send an acknowledgement card announcing your thoughtful gift to the honoree or a family member, please fill out the following:
First Last
Address
Street Address City State ZIP Code

Donation Form

Donation Form

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