Diabetes Education and Research Center
Donation Form

I support the work of the Diabetes Education and Research Center and would like to make a tax-deductible contribution to support your continued efforts.

Name: Organization: (Optional) Address: City, State, Zip: Telephone: Email Address:

________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________

Enclosed is my check in the amount of $_______________ payable to the Diabetes Education and Research Center. I understand that a receipt for my contribution will be mailed to me.

Mail to:

Diabetes Education and Research Center
PO Box 897
Philadelphia, PA 19105

Copyright © 2011 Diabetes Education and Research Center