Donation Form for 2010 Walk for Lupus Now
To donate online: Click Here.
To donate by mail: Use the form below.
—————————————–
SUPPORT ME AS I PARTICIPATE IN THE WALK FOR LUPUS NOW 2010
Team Name: __Team Metamorphosis____________
Participant Name: _Katina Rae Stapleton________________
Yes, I would like to make a contribution to help the Lupus Foundation of America Greater Washington Chapter in the amount of
____$250 ___$100 ___$75 ____$50 ____$25 ____Other amount (please note amount)
Name_________________________________________________________
Address_______________________________________________________
City___________________________________ State__________________
Zip code__________________________
Phone____________________________
Email_____________________________
If paying by credit card:
Name as it appears on credit card_______________________________________
Credit Card Number_________________________________________________
Credit Card Expiration Date ___________________________________________
Three digit security code (from back of card)______________________________
Please mail this form and your check (made payable to):
Lupus Foundation of America, Greater Washington Chapter
2000 L Street, NW – Suite 732
Washington, DC 20036
Attn: Walk for Lupus Now