Northeast Ohio Chapter
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Huntington's Disease Society of America Northeast Ohio Chapter |
Please take this opportunity to become an active Partner in Progress through involvement and contribution. Help the Huntington's Disease Society of America shape the future of HD families.
| Name _____________________________________
Address ___________________________________ City/State/Zip _____________________________ Telephone ________________________________ Comments/Questions _______________________ _________________________________________ _________________________________________ |
Partners in Progress Contributions __ New __ Renewal __ Address Change Annual Membership ___ $15 Individual ___ $25 Family Additional Contribution to fight HD ___$25 ___$50 ___$100 ___$500 ___Other $______ Total Amount $ _____________ |
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Please print this page and
mail with your check to:
Kenn M. Synek,
CPA, Treasurer |
Make checks payable to HDSA Northeast Ohio Chapter. Contributions are tax deductible as provided by law. |