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 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.