If you would like to donate via mail,
complete the form below, print it and mail it
(along with your check) to:
AVAC:
Global Advocacy for HIV Prevention
423 West 127th Street, 4th Floor
New York, NY
10027
To make a donation over the phone, call
212-769-6423 or 646-369-1473
Name____________________________________________________________________
Address____________________________________________________________________
City____________________________________________________________________
State________________________ Zip
Code_________________
Daytime
Phone____________________________________________________________________
Evening
Phone____________________________________________________________________
Gift Amount
$____________________________________________________________________
Check enclosed.
Charge my donation to my:
American Express
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Expiration Date ___________________
If this is a Memorial Gift or Tribute
Gift?
I am making this gift:
in memory of
in honor of
Name
___________________________________________________________________________
Occasion
________________________________________________________________________
If
an acknowledgement is to be sent to the
honoree:
Name
_____________________________________________ Address
______________________________________________________________________
City
_________________________________________________________________________
State________________________ Zip
Code_______________
Do not show my
name Message to appear on
acknowledgement: ___________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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THANK YOU for your generous
support!
AVAC: Global Advocacy for HIV Prevention
101 West 23rd Street · New York, NY
+1 212.796.6423 (main) · avac@avac.org
Copyright 2012, All rights reserved.
