Donation by qingyunliuliu


									                     GIFT/DONATION FORM
    Your gifts and donations help the work of the ABDA in locating patients with Behçetʼs Disease, providing information and
                           support to patients and their families, and educating medical professionals.
The American Behçet’s Disease Association is a 501(c)3 non-profit organization registered in the State of Minnesota. We provide many services to
persons with Behçet’s Disease, their families and the medical community serving them. The ABDA is only one organization and there are no local
chapters. Currently we do not receive any governmental funding or funding from any other source except contributions through membership,
private donations and ABDA fund-raising events. We rely on your contributions to fund all of our activities and support services. Would you please
consider a donation with a check, credit card, stock assets, or whatever you feel would be helpful? There is no donation that is too small to help us.
Thank you and we appreciate your support.

                         DONATIONS                                                                               GIFTS
We are a non-profit organization and rely on donations to fund                    Gifts are a wonderful way to let someone know you care. An
such events as the National Conference. Your donations also                       ideal gift for companies and vendors also because with each
go toward bringing information to Behçetʼs patients, healthcare                   gift, the listed person will get an acknowledgement of your
professionals, caregivers and family.                                             generosity.

                    Enclosed is my donation of $__________
                                                                                       I In Memory             I In Honor
                                                                                                        My Donation is a Gift:

                                                                                          of _______________________________________
                       Receipt Information:
Name:             __________________________________
Address:          __________________________________
                                                                                                     Acknowledge this gift to:
                                                                                  Name:             __________________________________
City:             __________________________________
                                                                                  Address:          __________________________________
State / Zip : __________________________________
                                                                                  City:             __________________________________
Telephone:        __________________________________
                                                                                  State / Zip : __________________________________
E-mail:           __________________________________                              I Please send the acknowledgement to me. (Receipt Address)
(Contributors are listed in our newsletter unless otherwise noted)                (Recipients are listed in our newsletter unless otherwise noted)
I Do not list in newsletter                                                       I Do not list in newsletter

                       PAYMENT TYPE                                                        ADDITIONAL INFORMATION
I Enclosed is my check for: ____________________                                       I Please send me information on planned giving,
                                                                                             estate planning and stock donations.
I VISA I MasterCard I Discover I Amex
                                                                                             Please send me information about how my
Name on Card: ________________________________                                               company can match my donation to the ABDA.

Card Number: _________________________________                                       Please fill out this form and mail with your gift or donation

Exp. Date: _________________ CVV Code: ________
                                                                                     (payable to The American Behçet’s Disease Association) to:

Signature: ___________________________________
                                                                                   ABDA • PO Box 80576 • Rochester, MI • 48308
                                                                                                   OR FAX TO: 1-480-247-5377

                                                                                                       - GIFT DONATION FORM -
 Give a very special “Occasion” gift!                                             Please list the details of the occasion here so we can send an appropriate
 Would you like to do something special for your loved one’s birthday,            acknowledgement letter or card to the recipient.
 anniversary or Holiday occasion? How about something that is unique and
 will really make a difference? Consider making a donation to the ABDA in         Who To: _________________________________________________________
 your loved one’s name. By doing so, you will help support the ABDA and
 its mission as well as educate others about Behçet’s Disease. For each dona-     Occasion: ________________________ Date of Occasion: ________________
 tion, we will send a personal note to the recipient telling them that your
 generous donation was made on their behalf. In addition, we will also print      Special note to be printed in Card: ____________________________________
 an acknowledgement in our newsletter. You can give a donation in several
 ways: Fill out the form above and the information to the right and fax it with   ________________________________________________________________
 Credit Card info, mail with your enclosed check or donate online at              Gift Amount to be noted in card: I YES   I NO We accept Visa/MasterCard/Discover or American
 Express. You can also contact the Secretary at with        From: ___________________________________________________________
 any questions or special requests. Thank you for considering the ABDA for
 your gift-giving needs.                                                          Your Telephone (in case we have questions) ____________________________


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