Gen Next Membership Contribution Form

Personal Information

First Name *

Middle Name

Last Name *

Email *

Phone *

Home Address *

City *

State *

Zip Code *

Have you been convicted of a felony? *

Yes

No

If yes, please explain:

Employment Information

Employer *

Occupation *

Contribution Amount *

$10,000 - Gen Next Standard Membership

$5,000 - Gen Next Semi-Annual Membership (2 automatic contributions of $5,000).

$5,000 - Gen Next Split Contribution ($5,000 to Gen Next and commit $5,000 to Gen Next approved efforts throughout the duration of membership term)

Other Amount

If Other Amount, Please enter the amount:

Memo/Note: (Optional)

Legal Compliance *

I affirm that the following statements are true and accurate:
Gen Next is a 501(c)(4) nonprofit organization. Contributions to the 501(c)(4) organization are not tax deductable as charitable contributions.