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DONATE NOW

rockCANroll, Inc., is a 100% volunteer, non profit 501C-3, hunger relief organization and think tank. Donations are tax-deductible!

Your contribution will fund innovative projects and events that restock the shelves of local relief agencies. rockCANroll supplies donated items to organizations that provide assistance to men women and children in need of basic assistance and lack food security.

Improving lives and empowering people.

A simple act of kindness CAN provide dignity and relief.

The concept is simple, the rewards are immense!

All checks should be made payable to: rockCANroll

Please print the form below & mail or fax it to:
rockCANroll
P.O. Box 700
Jericho, NY 11753
Fax: 516-822-3457

OR fill out and submit online:

Select a Donation Amount:
	$15 RCR Shirt	$18	$36	$50	$75	$100	$250
or Enter a Donation Amount
$ .00
Donor Information
First Name:*
Last Name:*
Phone Number with Area Code:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Payment Information
Cardholder's Name:*
Credit Card Number:*
Credit Card Type:*
Card Code (CVV):*
Credit Card Expiration:			Month Year
Billing Information
			If the billing information is the same as the contact information leave this area blank, otherwise, please fill out the information below:

Address Line 1:
Address Line 2:
City:
State:
Province:
ZIP/Postal Code:
Country:
Shirt Size (if applicable):
How Did You Hear About Us :
* Information (Fill in HERE):			please enter the name here

Thank you for your donation.

We CAN make a difference.

Or for more information, contact aimee@rockCANroll.org or call 516-822-3457