Donation Form for 2010 Walk for Lupus Now

To donate online: Click Here.

To donate by mail: Use the form below.

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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