Support Us by hYtEmT


									Support Us

Thank you for making a donation to ACLD. After fifty proud years of service to individuals with disabilities and their families, we
still have much work to do. Each contribution will help us to fulfill the promises we have made for the next fifty years. These
promises include continuing to provide state of the art services to children and adults with autism, providing improved options for
individuals with disabilities as they age and providing opportunities for all individuals with disabilities to live an enviable life.

Thank you for investing in our future and theirs.

Donation Information

Amount:           $1,000   ______                     Designation:      Annual Appeal               _____

                  $500     ______                                       General                     _____

                  $250     ______                                       COC                         _____

                  $100     ______                                       *In Memory of               _____

                  $50      ______                                       **In Honor of               _____

                  Other    ______

Donor Information:                                                      Payment Information:

Name: ______________________________________________                    Check (payable to ACLD)               _________

Address: ____________________________________________                   Pledge                                _________

____________________________________________________                    Credit Card (MC/Visa/Amex)            _________

Phone #:____________________________________________                    Cardholder’s Name:____________________________

E-mail:_____________________________________________                    Credit Card Number:___________________________

Relationship to ACLD: _______________________________                   Expiration Date: _______________________________

Solicited by:_________________________________________

Additional Information:

*My gift is in memory of: ______________________________________________          Please mail form to: ACLD

Acknowledgement to be sent to: ________________________________________           807 South Oyster Bay Road

___________________________________________________________________               Bethpage, New York 11714

___________________________________________________________________               Attention: Development Dept.

**My gift is in honor of: ______________________________________________          or

Acknowledgement to be sent to: _______________________________________            Fax to 516-822-0942



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