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INSTEAD
OF FLOWERS, OR IN ADDITION TO THEM —
DEDICATE A GIFT
IN
MEMORY OF A FRIEND OR LOVED ONE
OR
MAKE A DONATION IN TRUBUTE
Your gift is tax-deductible, and will support our work.
The Foundation is a tax-exempt, non-profit 501C3 group.
Thank you!
We
do not accept credit cards at this time.
Please print this page out, and mail it with your check to:
PO Box 492028
· Los Angeles · California 90049-8028
(310)471-0303 · www.Anti-smoking.org
Enclosed
is my contribution to The Foundation
for a Smokefree America. My gift is made in memory of the following person:
Name of deceased: _____________________________________
_____ Please
send a letter to the person listed below, and acknowledge that I have made
a gift to the Foundation for a Smokefree America.
I am enclosing $_____________.
____
Let the person below know the amount of my gift.
____
Keep the amount of my gift private, but let the person below know I have made
a donation.
____
I would prefer my donation to be anonymous, but let the person below know
a gift was made.
Please have the Foundation write a letter to
the following person, and let them know a gift was made.
First Name ___________________________ Initial_____
Last
__________________________________________
Company
(optional) _____________________________
Street
Address _________________________________
______________________________________________
City
_________________ State _____ Zip
__________
Phone
1 (optional) ______________________________
Phone
2 (optional) ______________________________
e.m.a.i.l.
(optional)
______________________________________________
My
info:
My First Name
________________________ Initial_____
Last
__________________________________________
Company
______________________________________
Mail
Address ___________________________________
______________________________________________
City
_________________ State _____ Zip
__________
Phone
1 (optional) ______________________________
This is only in case we
need to call you with a question.
Phone
2 (optional) ______________________________
Fax
(optional) __________________________________
Website (optional)______________________________
e.m.a.i.l.
(required if newsletter desired)
______________________________________________
When
it starts publication, I ____would ____would not like to recieve your newsletter
with news of the Foundation and tobacco news updates. (e.m.a.i.l. address required.)
I
understand I may unsubscribe at any time, and that my e.m.a.i.l., address and phone
will never be shared.
_____
I would like that my donation to cover my membership dues for one year. My
level of membership will be determined by the amount of my gift.
____
$15 Student
____
$ 25 - $35
____
$50
____
$100
____
$250
____ I pledge or enclose a gift of $ _______________.
_____I
will consider a major gift in the range of __________________.
Please have Mr. Reynolds call me to discuss my gift.
Detailed
information about the Foundation's
programs and mission is posted on the web at:
www.anti-smoking.org/info