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Please provide the following information:
First Name: __________________________________
Last Name: __________________________________
Address1: __________________________________
Address 2: __________________________________
City: __________________________________
State: __________________________________
ZIP Code: __________________________________
Home Phone: __________________________________
Business Phone: __________________________________
E-mail address: __________________________________
Donation Amount: ___________________________________
Payment by Check: YES NO Check No: ________________
Credit Card Type: __________________________________
Credit Card Number: ___________________________________
Name on Credit Card: __________________________________
Expiration Date: __________________________________
To make a donation on behalf of or in memory of another person, please enter the person’s name. (You will have a chance to notify this person about your dedication with a giving card after you complete the donation.) ________________________
_______ Payment Included
_______ Please bill me for my donation.
_______ Yes, please contact me about membership in the NSA!
Preferred Method of contact:
_______ E-mail
_______ Mail
_______ Home Phone
_______ Business Phone
Please print this page and mail to:
National Stuttering Association
119 W. 40th Street
14th Floor
New York, NY 10018
On behalf of all who stutter and the people who love them, thank you for your support!
If you have any questions, please contact us at 1-800-We Stutter or e-mail us at Giving@WeStutter.org.
NSA is an accredited 501(c)(3) nonprofit agency of the Internal Revenue Code. All donations are tax deductible subject to limitations under the Internal Revenue Code. A receipt will be provided via e-mail. Additionally, donations of $250 or more will receive a letter of acknowledgement.
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