Support Las Hermanas Gomez's fundraiser to Help Families Thrive! Donor Info First Name: Last Name: Email Address: Phone: Billing Address Country: United States of America Canada Mexico Afghanistan Åland Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Address: City: State: --Choose your state-- Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario P.E.I. Quebec Saskatchewan Yukon Province: Zip/Postal Code: Credit Card Registration fees and funds raised are non-refundable and 100% tax-deductible. Credit Card Number: Credit Card Expiration (mm/yy): 01 02 03 04 05 06 07 08 09 10 11 12 / 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 Name On Card: CVV Value: Comments: My donation, $: Anonymous? It is OK to show my name on your site. Please make my donation anonymous. Las Hermanas Gomez Target $2,000.00 Raised $1,035.10 Progress 52 % Team Members Alana Gomez-Wagner $665.00 Maria Angelita Gomez $370.10 Team Donors BMS Match to Alana Gomez-Wagner $250.00 To match Andrew Wagner's gift Anonymous Donor to Maria Angelita Gomez $0.10 Anonymous Donor to Maria Angelita Gomez $35.00 Anonymous Donor to Alana Gomez-Wagner $35.00 Laurie A Wagner to Alana Gomez-Wagner $50.00 Crazy but for a very good cause! Rick Gomez $100.00 You make us proud. Andrew Wagner to Alana Gomez-Wagner $250.00 Awesome! Alana Gomez-Wagner $30.00 Michael Zuber to Maria Angelita Gomez $5.00 Kick It! Maria Arnold to Maria Angelita Gomez $30.00 Andrea Keefe to Maria Angelita Gomez $25.00 You're an inspiration!! Anonymous Donor to Maria Angelita Gomez $50.00 Anonymous Donor to Maria Angelita Gomez $25.00 This is crazy, but I’m sure it will be amazing! Good luck! Anonymous Donor to Maria Angelita Gomez $50.00 James Rhoades to Maria Angelita Gomez $50.00 Way to go, Angel! Maria Angelita Gomez $50.00
