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GLHF Donation Form
(If you would prefer to make a gift online please go to our secure online donation page.)

Make your annual gift today, or set up scheduled installments.
 Simply complete the form below, print it, and mail to the address below.

Click to see What a Gift Can Give!
  

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
Please fill out this information After printing.
 
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
  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 Wednesday March 10, 2010.