Donations & Memorials

Donations can be made to commemorate special occasions, honor special individuals & accomplishments, or remember friends or loved ones who have passed away. Your gift will help fund research, education, services, and Camp Ho Mita Koda for children with diabetes.

Note: Please CLICK HERE to make a Swim or SCUBA for diabetes donation.

To help us acknowledge your gift correctly, please complete:

DONOR INFORMATION:
Name:	Mr. Mrs. Ms. Miss Dr. Mr. & Mrs. First: Last:
Address:
City:
State:	Zip:
Home Phone:
Work Phone:
E-Mail:
Thisgiftismadetothe:	2008 Annual Fund General Fund Steven P. Arnold Walkathon Lend Each A Hand (helps provide supplies to people in need) Fisher Medic Alert Bracelet Fund Dale Nash Fund Sallie Lybarger Fund
Designatemygiftto:	Diabetes Education and Services Camp Ho Mita Koda Dietrich Diabetes Research Institute Where most needed
In Honor of: In Memoriam of:
Credit Card:	Master Card Visa
Card #
Expires:
Please charge my One Time Only tax deductible contribution of: $
Please charge my Monthly tax deductible gift of: $ (5, 10, 20, 50 etc.) I and/or my spouse (spouse name: ) work(s) for a Matching Gift Company, increasing the value of my/our gift. Company(s) with gift matching: Download a List of Matching Gift Companies (68KB Acrobat .PDF file)
Please send notification of my gift to: The amount of your gift will not be specified.
Name:	First: Last:
Address:
City:
State:	Zip:

THANK YOU! Your gift is building a foundation for the future.