Tourette
Syndrome Association of
phone:
281-238-8096 fax: 281-238-0468
toll free: 1-866-896-8484
Cash Donation
Please
complete the necessary information below.
You will receive a tax letter for your files. If being sent as a tribute,
the honoree will receive a card acknowledging your donation (sans
amount). Please print your
information for clarity.
Your Name: _________________________________________________________________________
Your Address: _______________________________________________________________________
City: _________________________________ State: ________________ Zip: ______________
Phone: ___________________________________
Amount of Enclosed Donation: ___________________ Check Enclosed? ______
Credit Card: ____________________________________ Exp. Date: _______________
Name on Card: _____________________________________ (AmEx/Visa/MC/Discover accepted)
PLEASE FILL OUT THIS
SECTION ONLY IF DONATION IS A TRIBUTE:
Donated in name of: __________________________________________________________________
Their address: _______________________________________________________________________
City: State: Zip:
In Honor of (occasion): ________________________________________________________________
OR --In memory of: __________________________________________________________________
Other: _____________________________________________________________________________
Donor’s
Signature: Date:
Please mail your donation to:
Tourette Syndrome
Association of
Or fax form with credit card info to: 713-665-0906
The Tourette Syndrome Association of
Texas is a 501(c)(3) organization, qualified to receive charitable
contributions in accordance with IRS regulations.
