Memorial and Tribute Form

Honor someone you love or remember someone you miss by supporting the vital research needed to find a cure for diabetes and its complications.

The JDRF memorial and tribute program offers friends of JDRF a thoughtful, caring way to remember a loved one or celebrate a special occasion while contributing to our vital mission to cure diabetes.

There are so many reasons to give:  Celebrate a birthday or other milestone.  Make a holiday really special.  Honor an achievement.  Send “get well” wishes.  Recognize a wedding anniversary.  Show a friend or family member who has lost a loved one how much you care.

You can also use the program to raise money by asking others to give to JDRF in lieu of gifts for birthdays, graduations, weddings, anniversaries, bar/bat mitzvahs or any other celebration in your own life. Some families have raised thousands of dollars with way – and it all supports diabetes research.

Its easy to participate. Please send the JDRF office the following information:  Your contact information.  The name of the person in whose honor or memory you are making the gift.  The name and address of the person/people who should receive notification of your gift (for example, the honoree or surviving family member).  Your donation (check or credit card information).

To make a memorial or tribute donation, you can call the office at (401) 738-9898 or complete the memorial/tribute form and mail to:

JDRF, New England Chapter – Rhode Island Branch, 2374 Post Road Suite 203 Warwick, RI 02886

Once we process your information, we will send you an acknowledgement letter. We will also send a card to the honoree or next of kin notifying them that you have made a memorial or tribute gift (we do not disclose the amount of the gift). Gifts are processed and acknowledged within two to four businesses days of receipt.

JDRF Memorial and Tribute Form

Donation Type

Please check one:

 Memorial  Tribute

Person Being Remembered/Honored (as it should appear on the acknowledgement card)

In Memory Of:______

In Honor Of:______

Occasion (Birthday, Congratulations, Get Well, etc.):______

______

Person(s) to Notify of Gift

Name(s):______

Address:______

______

Donor Information (as it should appear on the acknowledgement card)

Name(s):______

______

Address:______

______

Phone:______

Payment Information

Donation Amount:______

Please check one:

 Check or Money Order (made payable to JDRF) Enclosed  Please Charge my Credit Card: ____Visa ____MC ____AmEx ____Discover

Name (as it appears on card):______

Card Number:______Expiration Date:______Signature:______

Please send completed form to: JDRF, New England Chapter – Rhode Island Branch, 2374 Post Road * Suite 203, Warwick, RI 02886 or fax to (401) 738-7162