Donations & Memorials

Donations can be made to commemorate special occasions, honor special individuals & accomplishments, or remember friends or loved ones who have passed away. Your gift will help fund research, education, services, and Camp Ho Mita Koda for children with diabetes.

To help us acknowledge your gift correctly, please complete:

DONOR INFORMATION:
Name:	Mr. Mrs. Ms. Miss Dr. Mr. & Mrs. First: Last:
Address:
City:
State:	Zip:
Home Phone:
Work Phone:
E-Mail:
This gift is made to the:	Robert J. Munz Memorial Fund Annual Fund Steven P. Arnold Walkathon Lend Each A Hand (helps provide supplies to people in need) Fisher Medic Alert Bracelet Fund Dale Nash Fund Sallie Lybarger Fund
Designate my gift to:	Diabetes Education and Services Camp Ho Mita Koda Dietrich Diabetes Research Institute Where most needed
In Honor of: In Memoriam of:
Credit Card:	Master Card Visa
Card #
Expires:
Please charge my One Time Only tax deductible contribution of: $
Please charge my Monthly tax deductible gift of: $ (5, 10, 20, 50 etc.) I and/or my spouse (spouse name: ) work(s) for a Matching Gift Company, increasing the value of my/our gift. Company(s) with gift matching: Download a List of Matching Gift Companies (68KB Acrobat .PDF file)
Please send notification of my gift to: The amount of your gift will not be specified.
Name:	First: Last:
Address:
City:
State:	Zip:

     

THANK YOU! Your gift is building a foundation for the future.