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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.

Please mail this completed form and your payment to:Your ...€¦ · Card Number: Expiration Date: Mo. My gift will be matched by: / Gift InformationPayment Information Charge my

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Page 1: Please mail this completed form and your payment to:Your ...€¦ · Card Number: Expiration Date: Mo. My gift will be matched by: / Gift InformationPayment Information Charge my

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.