| YES, I want to donate to the Inaugural MDA Stride N’ Ride Walk-a-thon on behalf of Lindsey Parrish and research for Friedreich’s Ataxia.
Please, put your information here Donor Name ___________________________ Company Name ________________________ Donor Address: Street___________________________________________________ City/State/Zip___________________________________________________________ Donor Daytime Phone # ( )_______________ Evening # ( )_________________ Donation Amount: Please Circle: $310 funds 5 minutes of research $248 funds 4 minutes of research $186 funds 3 minutes of research $124 funds 2 minutes of research $62 funds 1 minute of research Other ____________________ *Any donations are greatly appreciated! Card Type: AMEX VISA MC DISC Credit Card # _____________________________________ Exp. Date ____/____ Name printed on Card _________________ Signature _______________________________ Cash Check ** All checks should be made out to MDA for a record of your donation! ** Please contact us if you have any questions! (330-308-0699 or parrish@tusco.net) Thank you! |
 |
| $1 Donation |
| Click Buttons below to make donations with your credit card of from your bank account! |
| $5 Donation |
| $10 Donation |
| $25 Donation |
| Mary Lasker, a research scientist once said: "If you think research is expensive, you should try disease." Every $1 helps. To make a larger donation, please contact us sales@generousgems.com |
| Print and Mail this form to: MDA/Lindsey Parrish 393 Schoenbrunn Dr. NE New Philadelphia, Ohio 44663 |