Enclosed is my general contribution in the amount of:  $____________________

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Please make checks payable to (do not send cash): 

Parkinson's Network of Arizona,  500 West Thomas Road, Suite 720, Phoenix Arizona  85013-4496.  Phone  480-883-2002  E-mail: info@parkinsonaz.com Web site: www.parkinsonaz.org

YOUR NAME______________________________________________________________________

ADDRESS_________________________________________________________________________

CITY________________________________STATE______________________ZIP______________

TEL________________________________________FAX___________________________________

E-MAIL____________________________________________________________________________ 

 

This is a gift in Loving Memory Of:  _______________________________________________

This is a gift in Honor of:  _______________________________________________________

 

Please send an acknowledgement card of my donation to (Honoree or Family of deceased):

NAME______________________________________________________________________________

ADDRESS___________________________________________________________________________

CITY__________________________________STATE__________________ZIP__________________

Parkinson's Network of Arizona  is a 501 (c)(3) non-profit organization.  Contributions are tax-deductible.