Donate By Mail
If you would like to mail in your tax deductible donation, please print this form and send a check or money order to:
The Progeria Research Foundation, Inc.
P.O. Box 3453
Peabody, MA 01961-3453
ENCLOSED IS MY CONTRIBUTION FOR:
$2500
$1000
$500
$250
$100
$50
$25
Other
Optional:
In Memory of:
In Honor of:
CONTRIBUTOR INFORMATION
Name:
Address:
City:
State:
Zip Code:
E-mail Address:
Phone Number:
PLEASE ACKNOWLEDGE MY GIFT TO:
Optional:
If this is a gift in memory or in honor of someone and you would like to inform a third party of your gift, please provide the following information about them:
Name:
Address:
City:
State:
Zip Code:
Gift Cards
Donate to PRF and we will send a card in your name to a friend or loved one:
Examples of Types of Cards:
Congratulations!
Get Well
In Remembrance
Season's Greetings
Thank You
Other
Print the information for the person receiving the card
Name:
Address:
City:
State:
Zip Code:
Sender's name: