The National Lymphedema Network -NLN Donation Form

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9th NLN International Conference 9.22.2010

Conference Registration Now Open

NLN Position Papers: Risk Reduction, Treatment, Exercise, Air Travel, Training

Financial Assistance for Garments:

New Books:
100 Questions and Answers About Lymphedema

Lymphedema Management: A Comprehensive Guide for Practitioners

Updated NLN Online Patient Questionnaire

Patient participation in clinical trial

For Professionals: NLN Research Survey

Give the Gift of Hope: For the Present & for the Future

NLN Donation Form

The NLN welcomes donations at all levels. To make a standard $50 Individual Membership donation, please purchase a membership. For all other donations, please complete the form below. 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:

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:

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 of My Donation:	$
Choose One:	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:
Charge Card Number:
Expiration Date (00/00):
My Name (acts as your signature):

Please call me for my charge card info:

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.

Latham Square

1611 Telegraph Avenue, Suite 1111

Oakland, CA 94612-2138

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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