| DIAL, Inc. Donation
Application Form..... |
|
| I would like to donation to DIAL, Inc. Center
for Independent Living. |
| |
| Donation Options (tax deductible): |
| |
| Private Donation: |
| _______$10.00 |
| _______$25.00 |
| _______$50.00 |
| _______$100.00 |
| |
| Corporate Donation: |
| _______$100.00 |
| _______$250.00 |
| _______$500.00 |
| _______$1000.00 |
|
| |
| _______I want to receive newsletters ONLY |
| _______I want to receive activity notices |
| _______I wish to participate in DIAL events |
|
| |
| Corporate/Personal Name:__________________________________________ |
| Address:__________________________________________________ |
| City:__________________________________________________ |
| State and ZIP:__________________________________________________ |
| Telephone #:__________________________________________________ |
|
| |
| Send your donation check or money order to: |
| DIAL, Inc. |
| Center for Independent Living |
| 2 Prospect Village Plaza |
| Floor 1 |
| Clifton, NJ 07013-1918 |
|
| |
| If you wish to download the donation form,
please visit the |
| downloads page
located on the menu bar for the DIAL, Inc website. |
| |
|
