Test Form

Name(Required)

Prefix First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

My donation is for…(Required)

Monthly or One-time Gift?

Monthly Gift for Membership

One-time Gift for Membership

Donation Amount(Required)

One-time Donation Amount(Required)

Monthly Donation Amount(Required)

Do you want the Indiana State Park Pass that is included with your membership level?

We are required to purchase your State Park Pass from the Indiana Department of Natural Resources. Please let us know if you’d like to help offset the cost of your Indiana State Park Pass and increase the impact of your gift! Or, you can keep your donation amount the same.

Do you want the Indiana State Park Pass that is included with your membership level?

Do You Qualify for a Golden Hoosier Park Pass?

Donation Designation and Tribute Gifts

Please use the form below to tell us if your donation is In Memory/Honor of someone; or if it should be designated for a specific program, project, or purpose.

Brick

Total

Monthly total

Credit Card

Feed Required: To use the Stripe field, please create a Stripe feed for this form.

Brick Information

Using the “Line” boxes below, please let us know what information you want included on your brick. Each brick can have up to 3 lines of text and each line can have a maximum of 14 characters (including all spaces and punctuation).

Line 1*

0 of 14 max characters

Line 2*

0 of 14 max characters

Line 3*

0 of 14 max characters