Lourie Center
Online Gift Form
Making an online gift to the Lourie Center is confidential and secure

Please complete the following gift form and click "Donate Now". All fields marked with * are required.

Donor Information


First Name, MI, Last Name*:
Email*:
Phone*:
Please list me/us in your annual report of donors as:

You can easily multiply the effect of your gift to the Lourie Center if you or your spouse work for a company with a matching gift program. Contact your Human Resources Office to find out how simple matching gifts can be!

Matching Gift Information:

My gift will be matched by
My Company
My Spouse's Company

Company Name:
Matching Gift forms may be mailed to: Lourie Center Development Office, 12301 Academy Way; Rockville, 2085

Tribute Information
A card will be mailed to the person you indicate. You may also choose to send an E-card at the time of payment.
This gift is In Honor of :
Or In Memory of:

Mail card and gift notice to:
Recipient's Street Address:
Street Address Line 2:
City:
State/Province:
Zip/Postal Code:
Country (If not US):
Make Your Gift
Comments:

By pressing "Donate Now" you will end up on secure server to give your credit card information and authorize the Lourie Center to charge your account the amount entered above.

If you have any questions or if you prefer to make your gift or pledge by telephone,
please call (301) 984-4444, extension 310.

To make your gift by mail, please print this form, complete it, and mail with your
check or credit card information (made payable to Reginald S. Lourie Center) to:

Lourie Center Development Office
12301 Academy Way
Rockville, MD 20852

(301) 984-4444, ext. 310
Email: development@louriecenter.com

Thank you for supporting the Lourie Center!

Your gift to the Lourie Center, a 501(c)(3) non profit agency, will provide the vital resources necessary for ensuring that at-risk infants, young children and their families get a healthy emotial start in life. All contributions are tax decuctible in accordance with federal law.