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Donate by Mail or Phone

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
Visa
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Discover
Card Number ___________________________________
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:
___________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________


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.
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