ISMRD Donation/Informational Form

Donation / Informational Request Form
I would like to contribute the following (check one):		Please give us your name & how to contact you:
________	$ 100.00	Name:
________	$ 50.00	Street Address:
________	$ 25.00	Address 2:
________	Other Amount: $ ___________	City:
________	Please put me on your newsletter mailing list!	State/Province:
________	Send me a brochure about ISMRD	Country:
Thank you for your interest in ISMRD!		Postal Code:	Email: _______________________ Phone: _______________________

From your browser print this form, fill it out and mail your check along with this form to:

Make all checks payable to ISMRD. If you live outside the U.S. you may want to check how your nation's currency converts to the American dollar to be sure it converts to the amount you intend to donate. To do this try the Universal Currency Converter.

ISMRD is a 501( c )(3) charitable organization based in the United States serving a global constituency. We provide our services, including our website, newsletter, outreach activities and support of research, without requiring monthly dues or any other financial restrictions. We gratefully accept donations that will enable us to continue toward our goal of a future free of the tragic consequences of Lysosomal Storage Disorders. If you would like to verify ISMRD's nonprofit status see our listing on Guidestar!