"Making a difference in the Lives of Diabetics all over the world"

If you are making a memorial contribution, please let us know the name of the person the gift is in memory/honor of as well as a name and address of someone to notify of your gift. We will mail them a thank you letter that recognizes their tax deductible donation.

Print this form, fill it and mail to: 

      Donation made by: ______________________________________
  
               Address: ______________________________________ 
   (for thank you note)
                        ______________________________________

                        ______________________________________

Donation amount: $ _____________

Optional Information:

   Donation made in [ ] Memory     [ ] Honor
                                   Occasion: ____________________


   Person's name: ____________________________

   Name of person to
   notify of donation: _______________________

   Address of person to
   notify of donation: _______________________

WE ARE IN DESPERATE NEED OF DONATIONS OF PARADIGM INSULIN PUMP SUPPLIES. IF YOU HAVE ANY PARADIGM SUPPLIES YOU ARE WILLING TO DONATE, WE WOULD GREATLY APPRECIATE IT.

Thank you very much for your support
All gifts are tax deductible to the extent permitted by law.

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