Memorial and Tribute Form

Memorial and Tribute Form

<p> Honor someone you love or remember someone you miss by supporting the vital research needed to find a cure for diabetes and its complications.</p><p>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.</p><p>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.</p><p>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.</p><p>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).</p><p>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: </p><p>JDRF, New England Chapter – Rhode Island Branch, 2374 Post Road Suite 203 Warwick, RI 02886</p><p>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.</p><p>JDRF Memorial and Tribute Form </p><p>Donation Type</p><p>Please check one: </p><p> Memorial  Tribute </p><p>Person Being Remembered/Honored (as it should appear on the acknowledgement card) </p><p>In Memory Of:______</p><p>OR</p><p>In Honor Of:______</p><p>Occasion (Birthday, Congratulations, Get Well, etc.):______</p><p>______</p><p>Person(s) to Notify of Gift </p><p>Name(s):______</p><p>Address:______</p><p>______</p><p>Donor Information (as it should appear on the acknowledgement card) </p><p>Name(s):______</p><p>______</p><p>Address:______</p><p>______</p><p>Phone:______</p><p>Payment Information </p><p>Donation Amount:______</p><p>Please check one: </p><p> Check or Money Order (made payable to JDRF) Enclosed  Please Charge my Credit Card: ____Visa ____MC ____AmEx ____Discover </p><p>Name (as it appears on card):______</p><p>Card Number:______Expiration Date:______Signature:______</p><p>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</p>

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