Scleroderma Foundation - Donate to the Scleroderma Foundation by mail.

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Send form with your check or credit card information to:

Scleroderma Foundation
Attn: Donations
300 Rosewood Drive Suite 105
Danvers, MA 01923


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To Donate By Mail

Print out this form and complete this form.

I would like to Become a Member and help support the Scleroderma Foundation's efforts to improve the lives of those with scleroderma, and to assist in the search for a cause and cure. Enclosed please find my check (or credit card information) in the amount of $___________ (first $25 goes towards membership).

Name:

Billing Address:

City:

State/Zip:

Country:

Telephone:		Email:

Credit Card #:		Exp. Date:

Name on Card:

Reason for donation (check one):	My donation is a tribute to someone special. Name: ______________________________________
	Please notify: _________________________________ of my donation. Address: _________________________________________________
	My donation is a memorial to someone special. Name: ______________________________
	Please notify: _________________________________ of my donation. Address: _________________________________________________
	I don't want to become a member; I only want to donate.

Last Updated 2/6/12

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