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Gifts
of Support to
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Dedicated
to Spinal Cord Injury Survivors and Research
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| If you
would like to make an immediate difference in someone's life and help fund
research for a cure, please print the form, complete the information below
and mail to: |
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Travis Roy Foundation |
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Attn: Brenda Taylor,
Foundation Administrator |
| 111 Huntington Avenue, Prudential Center, 19th Floor |
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Boston, MA 02199-7613 |
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Please accept my tax
deductible* contribution of $___________
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Check/Money Order Enclosed (Please make payable to "Travis Roy Foundation") |
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VISA ___ MC ___ AMEX
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| exp. ___/___ |
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Name as it appears
on credit card: |
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Signature: |
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*Contributions are tax-deductible as allowed by law. Consult with your
tax advisor.
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| Your Name:
_________________________________________________________________________ |
| Address:
____________________________________________________________________________ |
| City: ____________________________
State/Province __________ Zip/Postal Code ____________ |
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| Please accept my
gift... |
| In memory
of: _______________________ |
| In honor of: _________________________
on the occasion of _________________________________ |
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Please send an
acknowledgement to...
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Name _____________________________________________
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| Address
___________________________________________ |
| City:
____________________________ State/Province __________
Zip/Postal Code ____________ |
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Thank you for helping us make a difference |