Donate Via Credit Card on PayPal
To make your tax deductible donation, via PayPal, please click on the link above and then:
Click on "Make a Donation."
Leave "Item" blank.
Insert an amount in "Unit Price."
Click on "Update Totals."
Follow the instructions from PayPal.
If you need a further receipt for tax purposes, or would like a letter sent in honor, memory, or commemoration, please notify us via e-mail, providing (in the e-mail) the information requested in the form below. Our e-mail address is: staff@adiwebsite.org.
Donation Form (For Traditional Mail)-American Dysautonomia Institute
Suite 2
2135 Oakbrook Blvd.
Commerce Twp., MI 48390
Phone: 248-470-3992
E-mail: staff@adiwebsite.org www.adiwebsite.org
Reaching For A Cure
Your contribution is tax-deductible pursuant to Sec. 170 of the Internal Revenue Code
Please Print All Information
Date:_______________
Enclosed is my gift of $____________________________________made payable to
the American Dysautonomia Institute.
Your name_______________________________________________________________
Address_________________________________________________________________
City___________________________________State__________Zip Code____________
E-mail and/or phone_______________________________________________________
How do you wish the card to be signed?
_________________________________________________________________________
Please send notification letter to:
Name____________________________________________________________________
Address__________________________________________________________________
City____________________________________State__________ Zip Code___________
Your gift may be made as a memorial, honor, or commemorating donation.
Please complete the following:
In honor of:_______________________________________________________________
In memory of:_____________________________________________________________
Commemorating:___________________________________________________________
________________________________________________________________________(Please indicate birthday, wedding, anniversary, bar/bat mitzvah, communion or other event)
Special instructions (if any):_________________________________________________
________________________________________________________________________
With your generous help we can speed the day when dysautonomia can be promptly diagnosed, effectively treated, and then cured.
Please Complete and then Print this Form. Mail It, with Your Check Made
Payable to the American Dysautonomia Institute, to:
American Dysautonomia Institute
2135 Oakbrook Blvd.
Commerce Twp., MI 48390
Please Print This Page and Mail with Your Donation
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