Gifts by Mail or Fax

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 Gifts by Mail or Fax Powered By Docstoc
					Gifts by Mail or Fax

Please print this form, and mail it with your check or credit card information to: Development Office Pan American Health and Education Foundation P.O. Box 27733 Washington, DC 20038 Or fax your credit card information to: 202-974-3636
If you have questions or comments, please contact our Development Office at 202-974-3416.

Yes! I'll help save lives and build a healthy future for people in need by making a gift of: $1,000 $500 $250 $100 $50 $25 $15 Other ________ Name:________________________________________________________________ Billing address:________________________________________________________ City:___________________ State:___________________ ZIP:_________________ Country: _____________________ Phone: _______________________ E-mail: _________________________________ I have enclosed a check payable to Pan American Health and Education Foundation. Please charge my gift to my: Visa MasterCard American Express Discover

Cardholder name: _____________________________________________________ Card Number: ____________________________________Expiration Date: _______ Signature: ____________________________________________________________
Please Direct My Gift to The Area of Greatest Need My gift helps ensure the support of priority health needs in the Americas. The Foundation works across diverse areas of health and health education with a focus on promoting Healthy Living. Other (please specify) _______________________

Additional Information: Please tell us how you learned about us___________________________________ My employer has a matching gift program. I am including the appropriate form. Employer Name _________________ I am interested in including the Foundation in my will. Please send me more information about bequests. I would like to receive periodic updates about the work of the Foundation. I know other people who would be interested in learning about the Foundation. Please send an e-invitation to subscribe to the Foundation's e-announcements to the following email address(es): _________________________________ _________________________________ _________________________________
Pan American Health and Education Foundation, 525 23rd Street, NW. Washington, DC 20037-2895

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