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DONATE NOW
Yes, I want to join Asian & Pacific Islander Wellness Center's Families
Campaign 2000-2003!
You may make tax-deductible donations to A&PIWC; by check, credit card, or
gifts of stock. You may also make monthly or quarterly pledges. Your
workplace may match your contributions. As well, several individuals
have included A&PIWC; in their wills.
Enclosed in my gift of:
[ ] $1,000 [ ] $500 [ ] $250 [ ] $100 [ ] $50 [ ] Other __________
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Please charge my donation to my credit card:
[ ] American Express [ ] Master Card [ ] Visa
Card Number: ____________________
Expiration Date (mm/yy): __________
Full Name as it appears on your card: ____________________
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Please contact me about:
[ ] making a gift or pledge
[ ] becoming a Campaign Co-Chair
[ ] volunteering
[ ] including A&PIWC; in my will
[ ] making a gift of stock or other appreciated assets
[ ] making a gift to A&PIWC; in honor or in memory of and individual or group
[ ] Send me information about A&PIWC;'s programs and services.
[ ] I would like to receive periodic e-bulletins (include your e-mail address below)
[ ] Please do NOT publish / list my name as a donor in A&PIWC;'s newsletter or on this website.
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Name:
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Organization/Employer:
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Address:
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City:
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State:
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ZIP:
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Day phone:
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Fax:
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Email:
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Please print out this form and mail or fax it to:
Families Campaign
Asian & Pacific Islander Wellness Center
730 Polk Street, 4th floor
San Francisco, CA 94109-7813 USA
Fax: 415.292.3404
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