Donation Forms Archive - ASSERT Empowerment Self Defense

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21 October 2021

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Corporate Partnerships

$ Donation Amount:

Would you like to help cover the processing fees? I'd like to help cover the transaction fees of 0 for my donation.

Dedicate this Donation

Yes, please
No, thank you

Dedication Type

In honor of
In memory of
On behalf of
In celebration of

Honoree Details

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Last Name *

Would you like us to notify anyone of your donation?

Yes, send an eCard
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Notification Details

First Name *

Last Name *

Email Address *

Select Payment Method

Stripe - Credit Card
Offline Donation
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Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

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Make this an anonymous donation.

Comment

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Credit Card Info

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Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $1.00

{amount} donation plus {fee_amount} to help cover fees.

29 January 2021

1 of 100 donors

Corporate Partnerships

Do you want to sponsor a member of your community to get certified in and establish an ASSERT Program in your community? Help us reach our goal of establishing ASSERT Empowerment Self Defense Education Programs in a minimum of 100 locations around the country by 2025!

Help Support the ASSERT Mission

$ Donation Amount:

$5
$10
$25
$50.00
$100.00
$250.00
$500.00
Custom Amount

Would you like to help cover the processing fees? I'd like to help cover the transaction fees of 0 for my donation.

Make this donation every

Dedicate this Donation

Yes, please
No, thank you

Dedication Type

In Honor of
In Memory of

Honoree Details

First Name *

Last Name

Would you like us to notify anyone of your donation?

Yes, mail a card
Yes, send an eCard
No thanks

Notification Details

Personalized Message * 500 Characters left

First Name *

Last Name

Email Address *

Notification Details

Personalized Message * 500 Characters left

First Name *

Last Name

Country *

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

Select Payment Method

Stripe - Credit Card
Offline Donation
Stripe - Checkout

Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

Email Address *

Make this an anonymous donation.

Comment

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Subscribe to our newsletter

Donation Total: $5.00 One Time

{amount} donation plus {fee_amount} to help cover fees.

29 January 2021

The form does not have Goals enabled.

Help Support the ASSERT Mission

Help us meet our goals and bring empowerment self defense education to everyone.

Help Certify a New Instructor

$ Donation Amount:

$5
$10
$15
$50.00
$100.00
$250.00
$500.00
Custom Amount

Would you like to help cover the processing fees? I'd like to help cover the transaction fees of 0 for my donation.

Dedicate this Donation

Yes, please
No, thank you

Dedication Type

In honor of
In memory of
On behalf of
In celebration of

Honoree Details

First Name *

Last Name *

Would you like us to notify anyone of your donation?

Yes, send an eCard
No thanks

Notification Details

First Name *

Last Name *

Email Address *

Select Payment Method

Stripe - Credit Card
Offline Donation
Stripe - Checkout

Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

Email Address *

Make this an anonymous donation.

Comment

Create an account

Already have an account? Login

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $5.00

{amount} donation plus {fee_amount} to help cover fees.

28 January 2021

0 of 100 donations

Help Certify a New Instructor

This Is My Voice

$ Donation Amount:

$5
$10
$15
$50.00
$100.00
$250.00
$500.00
Custom Amount

Would you like to help cover the processing fees? I'd like to help cover the transaction fees of 0 for my donation.

Dedicate this Donation

Yes, please
No, thank you

Dedication Type

In honor of
In memory of
On behalf of
In celebration of

Honoree Details

First Name *

Last Name *

Would you like us to notify anyone of your donation?

Yes, send an eCard
No thanks

Notification Details

First Name *

Last Name *

Email Address *

Select Payment Method

Stripe - Credit Card
Offline Donation
Stripe - Checkout

Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

Email Address *

Make this an anonymous donation.

Comment

Create an account

Already have an account? Login

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $5.00

{amount} donation plus {fee_amount} to help cover fees.

28 January 2021

0 of 100 donors

This Is My Voice

Through support, continuing education, and networking, we can help AESD Leaders from your community exert the influence necessary to serve as the engines for positive change.

You Can Be Assertive

$ Donation Amount:

$5
$10
$15
$50.00
$100.00
$250.00
$500.00
Custom Amount

Would you like to help cover the processing fees? I'd like to help cover the transaction fees of 0 for my donation.

Dedicate this Donation

Yes, please
No, thank you

Dedication Type

In honor of
In memory of
On behalf of
In celebration of

Honoree Details

First Name *

Last Name *

Would you like us to notify anyone of your donation?

Yes, send an eCard
No thanks

Notification Details

First Name *

Last Name *

Email Address *

Select Payment Method

Stripe - Credit Card
Offline Donation
Stripe - Checkout

Personal Info

First Name *

Last Name

Is this donation on behalf of a company?

Company Name

Email Address *

Make this an anonymous donation.

Comment

Create an account

Already have an account? Login

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $5.00

{amount} donation plus {fee_amount} to help cover fees.

1 June 2020

0 of 100 donors

You Can Be Assertive

Let’s bring ASSERT Empowerment Self Defense to every community in need! Help your community ASSERT ESD Program flourish with your donation.

Donation Forms

Corporate Partnerships

Honoree Details

Notification Details

Corporate Partnerships

Help Support the ASSERT Mission

Honoree Details

Notification Details

Notification Details

Help Support the ASSERT Mission

Help Certify a New Instructor

Honoree Details

Notification Details

Help Certify a New Instructor

This Is My Voice

Honoree Details

Notification Details

This Is My Voice

You Can Be Assertive

Honoree Details

Notification Details

You Can Be Assertive

Welcome back,