Donation Form
Donation
Action on Addiction Inc. (Registered in Delaware, a 501(c)(3) Non-profit Company, Tax ID # 31-1674193)
Addiction is the biggest preventable killer in the UK. It breaks up families, damages communities and
destroys lives. In some way it touches us all. We take action to disarm addiction. We do this through
funding the UK charity, Action on Addiction, that supports research, treatment, family support,
education and training in the addiction field.
Please help us take action on addiction by supporting this work.
Yes—I would like to support Action on Addiction Inc.
Your name __________________________________________________________________
Street ________________________________________________________________
City__________________________ State___________________ Zip Code______________
2. I enclose a check for:
$___________________________
Your signature __________________________________ Date_________________________
“” the box if you require a receipt for this donation for income tax purposes
Please return this form to:
Action on Addiction Inc.
c/o Chapel & York Ltd.
1000 N. West St., Ste. 1200
Wilmington, DE 19801