Donation Form for US SupportersInternational Donors My DonationDonation Amount*$500$250$100$50OtherOther Amount Your Donation $0.00 Type of Donation*One TimeMonthly RecurringMy InformationName* First Last Email* Phone Yes, you can contact me in the future. My Payment InformationCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Address* Address Line 1 Address Line 2 City State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Postal Code Amount $0.00 Donate This iframe contains the logic required to handle Ajax powered Gravity Forms. All or part of your gift to the Jerome Lejeune Foundation USA, a 501(c)(3) organization, may be tax deductible as a charitable contribution. Please check with your tax advisor. No goods or services were received in exchange for this contribution.