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Camp AZDA Donation Record

DonorName:

EMail:

Address:

Phone:

_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

IamdelightedtohelpsupportCampAZDAbycontributingthefollowinggift(s):
__________________________________________________________________________

Gift Method(s)
Enclosedisacheckfor__________________________________________________
Pleasechargemycreditcardforthisamount:$_______________________________
cc#:______________________________________expirationdate:_____________
nameoncard:_________________________________________________________
signature:____________________________________________________________
IllarrangefordeliveryofmyinkinddonationwiththeADA.Pleasecontactmeat
(phoneoremailaddress):________________________________________________

GiftReceivedby:__________________

Date:_________________

TheAmericanDiabetesAssociationisa501(c)(3)taxexemptorganization.
Donationsaretaxdeductibletotheextentpermittedbylaw.
TaxID131623888.Forquestions,contactjgarcia@diabetes.org
Donationsmaybesentto:
AmericanDiabetesAssociation
CampAZDA
5333N.7thStreetSuiteB212
Phoenix,AZ85014.

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