Support Your Chapter and Caucus

Thank you for supporting your community. While DignityUSA works on a national scale, it's the work of our chapters and caucuses that meets the needs of their communities.

Contribution Amount

Sponsor - $ 10.00

Supporter - $ 25.00

Benefactor - $ 50.00

Contributor - $ 100.00

Friend - $ 250.00

Patron - $ 500.00

Angel - $ 1,000.00

- other -

Other Amount

I'd like to cover the credit card processing fee.

This will add 2.6% to your contribution. Thank you!

Total Amount

I want to contribute this amount every month

In Honor of In Memory of

Select an option to reveal honoree information fields.

Individual Prefix

First Name

Last Name

Email Address

Community Donation Information

Which Community

Dignity/Detroit

First Name *

Last Name *

Street Address (Home)

City (Home)

Postal or Zip Code

Country (Home)

State or Province

Email (Primary) *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province

Postal Code

Additional Information

I wish for this contribution to be anonymous

Yes No

Referrer