Potosi Pines Camp www.potosipinescamp.org Online Donation Form Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Church Affiliation(Optional)Fund Selection*Please select one of the following fundsAnnual Fund (Unrestricted donations to support the ministry and initiatives of Potosi Pines Camp.)Scholarship Fund (Designated donations restricted for use to provide scholarships to campers at Camp and Retreat Ministry hosted events at Potosi Pines Camp.)Endowment Fund (Designated donation to increase base principal of the Potosi Pines Camp Permanent Endowment Fund. Interest of fund is utilized at the discretion of the Board of Camp and Retreat Ministries per the Permanent Endowment Fund Policy.)Capital Fund, Unrestricted (Unrestricted donations to support future capital improvements and maintenance at Potosi Pines Camp.)If you desire to make a donation toward a particular cause or initiative not included on this page, please contact Dina Reid at firstname.lastname@example.org, (602) 266-6956, or (800) 229-8622.Donation Amount* Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.