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2014 Conference Information

Risk Reduction in the News – Response from the NLN Medical Advisory Committee

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NLN Donation Form

NLN Donation Form

The NLN welcomes donations at all levels. Thank you for supporting the work of the National Lymphedema Network and those we serve.

Note: You can either fill out this form and submit it online, or print it out from your browser and mail it to the address below.

Please accept my donation as follows:

1. My Contact Information My Name: Address: City: State: Zip: Phone Number: Required for charge card transactions. Full Email Address: Required to receive an automated receipt of today's donation.

2. Honoree Information (Optional) This is a gift      in honor of:      in memory of: Name of Honoree: (required) Address: City: State: Zip: Choose One: Please send a tribute letter to my honoree. Please do not send a tribute letter to my honoree. Optional Comment: If you wish, you may indicate the occasion and/or include a brief statement about this person/your donation. Your text will be included in the note we send to your honoree to alert them of your donation (if you request that a letter be sent). Choose All That Apply: Please send me a copy of the tribute letter. Please include the donation amount in the tribute letter.

3. Amount of Donation Please indicate the LEVEL of today's gift: $50-100 $101-500 $501-1,000 $1,001-5,000 Silver Supporter: $5,001-25,000 Gold Supporter: $25,000+ Other Amount Donor Options: Yes, it's okay to list my name in the annual NLN Donor List. Please do not list my name in the annual NLN Donor List. Please list my donation as "Anonymous". Please list my name as: For individual donations of $100 or more: Yes, I would like a one-year subscription to LymphLink.

4. Method of Payment Please charge my: VISA M/C American Express Discover I'm paying by Check Charge Card Number: Expiration Date (00/00): My Name (acts as your signature): Please call me for my charge card info: at my phone number entered above at this number:

5. Additional Comments (Optional) If you have additional comments, please enter them here:

Areas of this form with a dark blue background must be filled in. Thank you.

NOTE: If you have selected to pay by check, you DON'T need to click 'Submit'. Instead, please print this form from your browser and mail it, along with your check, to: National Lymphedema Network, Inc. 116 New Montgomery Street, Suite 235 San Francisco, CA 94105 Note: When printed, the underlined fields must be filled in. Thank you.

The NLN is a 501(c)(3) non-profit organization, Federal Tax ID# 943068338. All donations are tax-deductible to the full extent of the law.

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