Donation Form - American Academy Of Child And Adolescent Psychiatry
ADVERTISEMENT
1MAIL-IN DONATION FORM
YES!
I want to make life changing progress
in the fight against childhood psychiatric illnesses.
GIFT INFORMATION
□
□
□
□
□
□
I CHOOSE TO DONATE
$50
$250
$684
$2,500
$3,500
Other $ ____________
:
Name_____________________________________
Business Name_________________________
(OPTIONAL)
Address___________________________________ City____________________ State______ Zip Code______
Email Address______________________________
I WOULD LIKE MY DONATION TO SUPPORT:
□
□
□
□
Medical Student Fellowships
Advocacy
CFAK
Where Most Needed
□
□
□
International Fund
Research
ECP Connect
DONATION METHOD
□
My check is enclosed (Please make payable to American Academy of Child & Adolescent Psychiatry)
□
□
□
□
A one-time donation. Please charge my:
Credit Card number: ________________________________ CSC Code_________ Expiration Date________
Name on Card: _____________________________________ Signature________________________________
□
A monthly donation. Please deduct $___________ from my credit card.
HONOR OR MEMORIAL GIFT INFORMATION
(OPTIONAL)
□
□
This gift is:
in honor of
in memory of___________________________________________________
OTHER INFORMATION
□
Please send me more information about the 1953 Society, AACAP’s bequest and estate gift program.
MAIL TO
AACAP
P.O. Box 96106
Washington, DC 20090-6106
AACAP is exempt under section 501(c)(3) of the IRS. Federal Tax ID: 13-1958990. This gift is tax deductible.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business