NAMI Secure Online Area--Credit Card--Donation Form

Enter Initial Donation to Create Your Memorial Fundraising Page

Your initial donation is the first step to creating your memorial page. After completing your secure donation you will be able to quickly and easily create a fundraising page in memory of your loved one that will allow you to:

  • Set a fundraising goal and track your progress toward achieving that goal.
  • Add a photograph and caption to personalize your page.
  • Write your own personal appeal message, letting people know why you are raising money.
  • Receive and display words of encouragement from those who donate to your memorial.
  • Send emails to family, friends and others encouraging them to visit your memorial and make a donation.

To begin, complete the information below and follow the prompts. If you have questions or concerns, please contact

If you wish to create a page honoring a special person in your life, please click here to create a tribute page.

$500 $100 $50 $35 Other $
First Name*
Last Name*
Address Line 1*
Address Line 2
Zip/Postal Code*
Email Address*
Daytime Telephone
In Memory Of:
Your Relationship to Memorialized
  Please send notification of this gift to:
Relationship to Memorialized
Address Line 1
Address Line 2
Zip/Postal Code

BBB Accredited Charity

  MasterCard, Visa, American Express, and Discover Card accepted
Card Type*
Card Number*
Card Expiration*  
Cardholder Name*
Card Security Code* (what's this?)


Please click "Submit Donation" one time only. Clicking this button more than once may result in double billing. Processing usually takes at least 10 seconds.

* These fields are required. Not filling in these fields will result in an error.

Contributions are tax deductible to the extent permitted by law.

NAMI truly appreciates your gift to help others.

You've made a difference!

If you have questions or comments regarding your donation,
please contact or 1-888-999-NAMI (6264), option 3.

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