Thank You For Your Support

This is a one time donation

Make this a recurring donation deducted

Suggested Donation Amounts:

$49 covers the cost of partial financial aid for one Ambassador

$149 covers the cost of full financial aid for one Ambassador

Other Amount

$250 provides partial program scholarship for one Ambassador

$500 partial scholarship for one Ambassador

$1,499 full scholarship for one Ambassador

Other Amount

First Name: Last Name: Company: Email: Mobile Phone: Address: City: State: Zip: - Comment:

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Billing Information

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Cardholder First Name: Cardholder Last Name: Cardholder Email: Billing Address: City: State/Province: Zip Code: - Country:

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E-Check Billing Information

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Check the box below if you prefer to send payment by mail:

Payment can be mailed to:

Young Black Leadership Alliance

4112 Old Pineville Rd

Charlotte, NC 28217

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