GLHF Donation Form

Make your annual gift today, or set up scheduled installments.
Simply complete the form below, print it, and mail to address below or
go to our secure online donation page

Please enter the name(s) you would like presented in our donor listing.
Name
Address
City

State

Zip

Phone

Email

I would like to support Great Lakes Hemophilia Foundation with a tax-deductible donation of:
 $1000         $500          $100         $50         $25         Other $
 
My (or my spouse's) employer will match this gift and I have enclosed the appropriate matching gift form.
 
Please designate my gift to support: This gift is made: (optional) In Memory Of     In Honor Of

Wherever it will do the most good
 Patient Financial Assistance
 Youth Campership
 Scholarship Fund
 Education/Support Services

Name(s)
     Please notify the following person of my gift:
Name(s)
                                          (required for notification)
Address 
        City  
      State   Zip

     Check Enclosed  Please make check payable to: Great Lakes Hemophilia Foundation (GLHF)

     Please Charge My Gift: In monthly installments*    In quarterly installments*   One time

  MasterCard     Visa
Card Number:  Expiration Date:

Signature: ________________________________________

*Monthly installments will be charged on or around the 15th of the month.
Quarterly installments will be charged on or about the the 15th of January, April, July, & October.

Additional Information

 I have included GLHF in my estate plans
 I request information about including GLHF in my estate plans
 
Comments/Questions:

Thank You - We Appreciate Your Support!
Great Lakes Hemophilia Foundation is a 501(c)(3) charitable organization.
Your gift is tax-deductible as allowable by law.
    

Contact Us | Donate | Home  

Great Lakes Hemophilia Foundation
(GLHF)
  638 N. 18th Street, Suite 108
Milwaukee, WI 53233
E-mail:  info@glhf.org

Phone: (414) 257-0200
Toll free:  (888) 797-4543
Fax: (414) 257-1225

  


Copyright © 1999, Great Lakes Hemophilia Foundation. All rights reserved.  Last updated Tuesday September 09, 2008.