THE CHANGE LAB

Donation Form - Fiscally Sponsored by Impact Hub Houston

DONOR INFORMATION

DONATION AMOUNT *

☐ $100
☐ $250
☐ $500
☐ $1,000
☐ $5,000
☐ $10,000
☐ Other Amount: $__________________________
Frequency: ☐ One-time ☐ Monthly ☐ Quarterly ☐ Annual

MAILING ADDRESS

Mail completed form with check to:

Impact Hub Houston
4201 Main St Ste L55c
Houston, TX 77002-9620

Make check payable to: "Impact Hub Houston"
Write in memo line: "Change Lab"

COMMENTS

TAX INFORMATION: Change Lab is fiscally sponsored by Impact Hub Houston, a 501(c)(3) nonprofit organization (EIN: 83-2379449). Your donation is tax-deductible to the full extent allowed by law. Impact Hub Houston will process your donation and provide an official tax receipt.

PREFERENCES & SIGNATURE

Send tax receipt Receive updates Keep anonymous
I understand that my donation will be processed by Impact Hub Houston as the fiscal sponsor for Change Lab. *