Our mission is to support and educate those affected by lupus and find a cure.

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Printable Donation Form

Printable Donation Form

Please print and mail this form to:

LUPUS ALLIANCE OF AMERICA LONG ISLAND/QUEENS AFFILIATE
2255 CENTRE AVE
BELLMORE, 
NEW YORK 11710

Name:  
Address:      
Phone:      
City: State: Zip:
         
Phone:      
Email:      
 
Enclosed is my gift of: $500 $100 $75 $50
  Other: $    
 
Memorial/Tribute Gift Name of Honoree:
     
Gifts of Caring Card: Thinking Of You Thank You
  Congratulations Get Well
 
Send acknowledgement of my gift to:
Name:    
Address:    
City: State: Zip:
 
Payment Method  
Check enclosed payable to Lupus of Long Island / Queens
Visa Mastercard  
Card Number: Expiration Date:
Name on Card:
 
No receipt is needed for my donation
Please keep my gift anonymous and do not include in any publications
I have included the Lupus Alliance of America, LI/Q Affiliate in my will
Please send me information on Planned Giving

All donations are tax-deductible to the extent allowed by law.

Lupus of Long Island/Queens is a 501(C)(3) not-for-profit organization incorporated under the State of New York.  A copy of our latest Annual Report may be obtained, upon request, from the Lupus Alliance or from the Office of the Attorney General, Charities Bureau, 120 Broadway, New York, New York 10271.

 

Posted by LupusLI on June 25, 2006 06:31 PM |

 
 
 
 

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