Explore, Enjoy and Protect the Planet

Chapter Refund Request Form Please provide the following information so that Member Care and Chapter Fundraising can process the refund. If you have any questions about the required information, please contact chapter.fundraising@sierraclub.org.

Your Information

First Name

Last Name

Email Address

Where did this donation originate?

Online Donation FormPaid Event from Campfire EventsBatch Gift EntryVirtual Terminal (WorldPay)

Was a credit card charged in this transaction?

YesNo

Overview

Is this refund on behalf of a Chapter or Group?

ChapterGroup

Chapter

Group Name

This refund is from a donation to a....

c3 account (with the Sierra Club Foundation, confirmation of donor intent may be requested)c4 account (like a general fund for a Chapter or Group)State-level Political Action Committee, or PACI don't know

Transaction Information

Donor First Name

Donor Last Name

Donor Member ID

Original Donation Amount

Original Donation Date

Refund Information

Is this a full refund?

Yes, it is a full refundNo, it is a partial refund

Refund Amount

We cannot process partial refunds for PAC accounts. Please select that this is a full refund.

Additional Comments

I acknowledge that this process is irreversible and cannot be undone. The information above is correct to the best of my knowledge.

Contact Information

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