I would like to contribute $ ___________________________
Name of Contributor ____________________________________
_____ Enclosed is a check payable to the Alliance for Lupus Research
This gift is _______ in honor of _______ in memory of
Person to be notified (if different) ___________________
_____ Visa _____ MasterCard _____ American Express _____ Discover
Card # _________________________________________________
Exp. Date _______________________________________________
Name on Card ___________________________________________
Federal Tax ID # 58-2492929
_____ My or my spouse's employer will match this gift. Enclosed is the matching gift form.
Please print out this form and make your tax deductible check payable to:
Alliance for Lupus Research
28 West 44th Street, Suite 501
New York, NY 10036
For more information on making a donation to the ALR, please call 212-218-2840.
people in the U.S. have Lupus.
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