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Gift Information Gift Designation
One-time gift amount: $
Payment Information
Yr./ Card Number: Expiration Date: Mo.
American Express Visa MasterCard Charge my credit card: Discover
Check is enclosed.
Matching Gifts:
Estate Gifts: I would like to learn more about planned giving opportunities.
Please assist us by including the corporation or foundation's matching gift form when mailing in your gift.
I have included a gift to the NAS, NAE or NAM in my estate plans.
My gift will be matched by:
First Name:
City:
Phone Number:
Postal Code: State: Country:
E-mail:
Last Name:
Address:
Billing Information
National Academies of Sciences, Engineering, and Medicine Office of Development P.O. Box 936138 Atlanta, GA 31193-6135
Please mail this completed form and your payment to:
(form updated February 2019)Your gift is tax deductible in accordance with IRS regulations.
Donor Name(s):
MAIL IN DONATION FORM
NAS Annual Fund NAM Annual Fund
Committee on Human Rights (CHR) NAE Independent Fund
Other:
Additional Instructions:
My gift is in honor of:
My gift is in memory of:
Phone: 202.334.2431 I Email: [email protected] I URL: www.nationalacademies.org/giving
Make a monthly gift of: $Your monthly recurring gift will be charged on the 15th of each month.