Check Donation Form
Please print out the following form and mail to:
North Alabama Sickle Cell Foundation, Inc.
P.O. Box 813
Huntsville, Alabama 35804
Name ____________________________________________________
Address __________________________________________________
City_______________________ State _____ Zip ______________
Day phone: _______________________ Evening Phone: __________________
Fax: _____________________ E-Mail ____________________
YES! I want to make a donation of:
_____ $25- will help N.A.S.C.F. make appearances to local
schools educating children and teachers about Sickle Cell Anemia.
_____
$50 - will help the N.A.S.C.F. distribute Sickle Cell Screening &
Counseling posters in more than a dozen public locations.
_____ $100 - will help the N.A.S.C.F. disseminate 1,000 Sickle Cell
Lapel Pins throughout the
_____ $500 - will help the N.A.S.C.F. print and distribute 1,000 bumper
stickers which say, "BREAK THE SICKLE CYCLE".
_____ $1,000 - will help the N.A.S.C.F. educate ten corporations on how
to support children with sickle cell.
_____ $2,500 - will help the N.A.S.C.F. support research for a cure for
sickle cell anemia. _____
$5,000 - will help N.A.S.C.F. train staff at ten hospitals on how to
treat sickle cell victims through crisis.
_____ $10,000 or more - will help the N.A.S.C.F. develop a Wellness
Clinic for Sickle Cell Anemia patients.
Other ____________
This gift is in honor of_____________________________
_____ I want to give by check. Check enclosed.
Please charge my (circle one): Visa Master Card
Credit card account no.: __________________________ Expiration date: __________
Signature: ___________________________
_____ Please send me more information about the N.A.S.C.F.'s work.
NOTE: If you would like to make a donation of goods or services, or volunteer your time, please contact the North Alabama Sickle Cell Foundation, Inc. at (256) 536-2723.