Membership

Membership Form

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Billing and Contact Information

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Middle Initial:

Last Name: *

Email: *

Country: *

Address: *

City: *

State: *

Province:

Zip/PostalCode: *

Phone:*

Make this donation anonymously

Display my Name as:

Your public posted comment:

Full Name

Custom Question

Additional Questions

Do You want to Volunteer?

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Honor/Memorial Gifts

I want to dedicate my donation to someone:

In Honor Of In Memory Of Tribute To

In Memory Of:

Honoree Name:

Send Email acknowledgement to:

Send Postal Mail acknowledgement:

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Dedication Message:

Payment Details

Credit Card eCheck

Routing Number: *

Account Number: *

Check Number: *

Account Type: *

Check Type: *

Name on Card: *

Credit Card Number: *

Card Verification (CVV): *

Expiration Date: *

CardExpirationYear

Invoice Number:

Purchase Order Number:

Name: *

Reference Number:

Terms & Conditions

Your membership to the Savannah Riverkeeper is 100% Tax Deductible as the Savannah Riverkeeper provided no Goods or Services in return for this membership (Tax ID 58-2630660). All financial transactions on our Web site, specifically online donations and online purchases, are managed through our payment processor, Click and Pledge, PCI Level 1 certified. All transactions use an encrypted channel, take place on secure servers and occur in real-time. No financial data, such as your credit card number, is transferred via a less-secure channel. Moreover, once your transaction has been completed, we do not retain your credit card number.

Charge Date

Charge me on: Payment will be processed and your card will be charged on this date

You will be charged:

Secured and Powered by Click&Pledge

Advanced Redirect

The patron will be redirect to the following pages based on the authorized result.

Important Note:

The redirect pages have to be secure otherwise no redirect will occur.
If your server is offline for any reason the redirect will fail, resulting in error. If the patron experiences a page not found based on your server’s availability it may result to double charges

Use complete URL including https://

Success landing page * :

Declined landing page * :

The following URL parameters are included in the response and may be used on the landing page via custom programming:

Example Success URL:
https://yourpageurl.com/success-page?on=123456&result=success&response=authorized&t=totalamount&refid=referenceid&trk=tracker

on = OrderNumber
result = success
response = authorized
t = totalamount
refid = referenceid
trk = tracker

Example Decline URL:
https://yourpageurl.com/decline-page?on=123456&result=failure&response=dcl&t=totalamount

on = OrderNumber
result = failure
response = dcl
t = totalamount

Membership Form

Your Membership designated total:

Honor/Memorial Gifts

You will be charged:

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Advanced Redirect

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