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Dana
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Donation Information
Thank you for taking the time to fill out your information.
What program would you like to designate your donation to?
*
General Donations
Sleeping Lodge Fund
Staff Dana
Meal Dana
Special-Needs Housing Fund
General Scholarship Fund
People of Color Scholarship Fund
Young Adults Scholarship Fund (Ages 18 - 35)
Nuns Fund
Please tell us where you'd like this donation to be put towards
For which retreat are you offering your staff dana?
Any (No preference)
Oct 09 - Oct 11 with Keri Pederson
Oct 16 - Oct 23 with Alexis Santos
Oct 30 - Nov 04 with Ayya Sobhana Bhikkhuni
Nov 06 - Nov 12 with DaeJa Napier
Nov 13 - Nov 16 with Tim Geil
Nov 17 - Nov 23 with Murray Kennedy and Patsy Boyer
Dec 02 - Dec 09 with Heather Sundberg
Dec 11 - Dec 16 with Keri Pederson and Tuere Sala, Assistant Teacher
Dec 30 - Jan 06 with Santikaro
For which retreat are you offering your meal dana?
Any (No preference)
Oct 09 - Oct 11 with Keri Pederson
Oct 16 - Oct 23 with Alexis Santos
Oct 30 - Nov 04 with Ayya Sobhana Bhikkhuni
Nov 06 - Nov 12 with DaeJa Napier
Nov 13 - Nov 16 with Tim Geil
Nov 17 - Nov 23 with Murray Kennedy and Patsy Boyer
Dec 02 - Dec 09 with Heather Sundberg
Dec 11 - Dec 16 with Keri Pederson and Tuere Sala, Assistant Teacher
Dec 30 - Jan 06 with Santikaro
Are you flexible as to the date on which your meal dana is offered?
*
Yes
No
What specific date are you requesting?
*
Do you wish to make your meal offering anonymously?
*
Yes
No
Do you wish to offer a special dedication to accompany your meal dana offering?
*
Yes
No
If you circle NO, please be aware our standard anonymous meal dedication reads:
"This meal is offered anonymously by someone present on this retreat" (or, as applicable "not present on this retreat").
If you would like to include a special dedication, please write out that dedication in the following box below exactly as you would like to have it read in its entirety. If you prefer not to include a special dedication, please be aware our standard non-anonymous meal dedication reads: "This meal is offered by Jane/John S. of YourTown, WA."
Special Dedication
*
What amount would you like to give to Cloud Mountain today?
$35
$50
$100
$250
$500
Other
Please tell us the amount you'd like to donate
$100 - Breakfast
$125 - Lunch/Brunch
$75 - Dinner
$300 - Full Day of Meals
Would you like to make this a recurring monthly donation?
*
Yes
No
For how many months?
*
Other Comments
General Information
First Name
*
Last Name
*
Street Address
*
Street Address Continued (Optional)
City
*
State / Province
*
Zip / Postal Code
*
Country
*
United States
Canada
Other
Please specify your country
Cell Phone
*
Alternate Phone
Email
*
Payment Summary
This retreat requires an initial $ deposit
*
Required Amount
Initial $ deposit.
Includes initial deposit plus any donations offered. Additionally, remaining balance will be charged on due date that is posted in retreat description and on your invoice.
Authorization (Initial Please)
*
By initialling, I authorize Cloud Mountain to process the payment of the amount above.
Payment Information
To donate by check or money order, please complete and print out this form and mail it along with your donation to the Cloud Mountain office at 373 Agren Rd. Castle Rock, WA 98611. Checks should be made payable to Friends of Cloud Mountain (or FOCM).
What kind of credit/debit card are you using?
*
-Please select a card type-
Visa
Mastercard
Credit Card Holder’s Name (as it appears on card)
*
Credit Card Number
*
Expiry Date (MMYY)
*
CVC/CCV Number
*
Billing Street Address
*
Billing Zip Code
*
Cloud Mountain 2020
Cloud Mountain 2020