The 2000 Life Member Class Gift
1.
Choose an amount:
150
300
500
1,000
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2000 Class Gift
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2.
Your information:
First Name
Last Name
Address
Address 2
City
State / Province
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Australian Capital Territory
British Columbia
California
Canal Zone
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Labrador
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New South Wales
New York
Newfoundland and Labrador
No. Mariana Islands
North Carolina
North Dakota
Northern Territory
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Queensland
Rhode Island
Saskatchewan
South Australia
South Carolina
South Dakota
Tasmania
Tennessee
Texas
Utah
Vermont
Victoria
Virgin Islands
Virginia
Washington
West Virginia
Western Australia
Wisconsin
Wyoming
Yukon
Country
USA
Canada
Mexico
United Kingdom
-
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Basutoland
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bophuthatswana
Borneo
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Terr
Brunei
Brunei Darussalam
Bulgaria
Burkina Faso
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Canal Zone
Canary Islands
Cayman Islands
Central African Republic
Chad
Channel Island
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Dem Rep Of The
Cook Island
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cwth. Ind. St.
Cyprus
Czech Republic
Dahomey
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
England
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Is (Malvinas)
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Terr
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Gibralter
Granada
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Is and McDonald Is
Holy See (Vatican City)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iran, Islamic Republic of
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Korea, Dem People's Rep
Korea, Rebublic Of
Kuwait
Kyrgyz Republic
Kyrgyzstan
Lao People's Dem Republic
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Fed States Of
Monace
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Nambia
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Guinea
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Ireland
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peoples Republic of China
Peoples Republic of Congo
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic of Korea
Republic of Moldova
Republic of South Africa
Republic of Zaire
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent
Samoa
San Marino
Santa Lucia
Sao Tome and Principe
Saudi Arabia
Scotland
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Slovinia
Solomon Islands
Somali Republic
Somalia
South Africa
South Georgia and the SSI
South Korea
Southwest Africa
Spain
Sri Lanka
St Vincent and Grenadines
Sudan
Surinam
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
UAE
Uganda
UK
Ukraine
United Arab Emirates
United Kingdom
United Rep of Tanzania
United States
Upper Volta
Uruguay
US Minor Outlying Islands
USA
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Vietnam
Virgin Islands
Virgin Islands, British
Virgin Islands, US
Wales
Wallis and Futuna
Western Sahara
Western Samoa
Yemen
Zambia
Zimbabwe
Postal Code
Email
Phone Number
List my name as
3.
Tribute information: (Optional)
Tribute type
<select tribute type>
In Honor of
In Memory of
Choose memorial only if the person you are honoring is deceased.
Honoree Name
Send a gift notification to: (Optional)
First Name
Last Name
Address
Address 2
City
State / Province
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Australian Capital Territory
British Columbia
California
Canal Zone
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Labrador
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New South Wales
New York
Newfoundland and Labrador
No. Mariana Islands
North Carolina
North Dakota
Northern Territory
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Queensland
Rhode Island
Saskatchewan
South Australia
South Carolina
South Dakota
Tasmania
Tennessee
Texas
Utah
Vermont
Victoria
Virgin Islands
Virginia
Washington
West Virginia
Western Australia
Wisconsin
Wyoming
Yukon
Postal Code
Email
Phone Number
4.
Payment details:
Credit Card
ACH / eCheck
Card Reader
Accepted Cards
Card Number
Expiration Date
01
02
03
04
05
06
07
08
09
10
11
12
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
Warning:
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CVV2 / CSC
Name on Card
Billing Zip Code
Name On Account
Account Number
Checking
Savings
Routing Number
Status
No data.
5.
Other questions: (Optional)
Contact me about donating appreciated securities.
Yes
No
My company will match this gift. I will direct the gift form to ALI.
Yes
No
I have already included ALI in my estate plan.
Yes
No
I would like more information on including ALI in my estate plan.
Yes
No
I would like to cover the fees for this transaction.
Your donation total including transaction fees is:
* includes all future recurring payments
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