<p> Donation Form for the AIHA Guideline Foundation Operating Fund</p><p>The AIHA Guideline Foundation (AGF) is exempt from federal income taxation under Section 501(c)(3) of the Internal Revenue Code. Contributions to the AIHA Guideline Foundation may be tax-deductible, as provided by law.</p><p>Your donation will be a valuable contribution in helping the AIHA Guideline Foundation meet its goals to develop and publish exposure guidelines on an ongoing basis.</p><p>______I would like to make a donation/pledge to the AGF Operating Fund.</p><p>______I would like to make a donation/pledge to support the development of ERPGs.</p><p>Payment Methods _____ I would like to make a donation by check or credit card: Amount enclosed is $ ______Check # ______Credit Card # ______Exp. Date: ______</p><p>_____ My company has a matching funds program.</p><p>_____ I would like to set up a pledge of $ ______over a _____year period. _____ Annually The first payment of $ ______is enclosed. _____ Semi-annually The first payment of $ ______is enclosed. (Not to exceed 5 years)</p><p>Date: ______</p><p>Printed Name: ______</p><p>Signature: ______</p><p>Address: ______</p><p>______</p><p>Phone: ______</p><p>E-Mail:______</p><p>Return to: AIHA Guideline Foundation, 3141 Fairview Park Drive, Suite 777, Fairfax, VA 22042</p>