2021 GO Team Donor – Fund Request Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Enter Email Confirm Email GO Team Member's Name*Please tell us in whose name you made your donation. First Last GO Team Name or DestinationPlease share the name or location of the GO Team this Team Member planned to participate on. This information should have been included in the email you received from Compassion Outreach (Ex: GO JAARS or GO Zimbabwe 1) Please select from the following options in regards to your 2021 GO Team donation:* I request that the funds originally given on behalf of the individual named above be used by Compassion Outreach to meet needs both locally and globally in this unprecedented time. I request to receive a refund of the funds I have personally donated on behalf of this individual. You have requested that the funds you gave on behalf of the individual named above be given to Compassion Outreach. Thank you for your generosity and for joining us in Making a Difference, Here & Now!You have requested to receive a refund of the funds you personally gave toward a GO Team that has been cancelled due to the Coronavirus Pandemic. If you have requested a refund for an online donation, please note that it may take up to 3 weeks to see the funds returned to your account. If your donation was sent in the form of cash or check, refunds will be issued by check through the US Postal Service and may take longer to receive. By selecting this option you acknowledge that once refunded your donation is no longer tax-deductible and therefore cannot be claimed as a charitable contribution on your tax return. There may be tax consequences including the need to file an amended tax return if you have already claimed this donation as a deduction. Any questions you have regarding tax consequences for this refund should be discussed with a tax adviser. Δ