DECLARATION FROM "EL YUNQUE" TO "MONT JUIC"
GIFT FORM
Name:________________________________________________________________
Address:______________________________________________________________
City:__________________________________________
State___________________Zip Code________________
Day Phone:______________________________________
Evening Phone:___________________________________
E-mail: _________________________________________
Gift Amount $_____________ written amount__________________________________
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Check Enclosed
Charge my gift to my: Visa Master
Card Number:_______________________________________________
Expiration Date:____ / _____
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Is this a Memorial Gift or a Tribute Gift?
I am making this gift: in memory of in honor of
Name:______________________________________________________
Occasion:_________________________________________________
(if applicable, eg. birthday, aniversary, graduation)
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Please send acknowledgement to:
Name:________________________________________________________________
Address:______________________________________________________________
City:__________________________________________
State___________________Zip Code________________
E-mail: _________________________________________
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Enclosed is my employers Matching Gift form
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Your gift is tax-deductable to the full extent of the law.
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THANK YOU for your generous support!
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Pacientes de SIDA pro Política Sana
Ronda C-1, Villa Andalucía,
San Juan, Puerto Rico 00926
[email protected]
[email protected]
Copyright © 2002 PW Graphics.
Page created 6 April 2002.