Your Contributions to the National Headache Foundation Help Fund Projects
What ’ s being done to help your headache problem ? There is an unprecedented amount of research being undertaken regarding migraine and other headache pain . The National Headache Foundation is involved in this effort with the help of funding from you . Contributions are a key part of the financial support of important headache research . Your gift provides funds for ( a ) NHF-financed research projects , ( b ) advocacy with health policy decision makers , and ( c ) patient-education initiatives . You can help ! The National Headache Foundation , the # 1 source for headache help , provides these services and many others through the generosity of people like you .
Please select one of the following giving categories :
❒ $ 250 ❒ $ 125 ❒ $ 100 ❒ $ 75 ❒ Other _________________
Name : _______________________________________________
Address : _____________________________________________
City : _________________________________________________
State / Zip : ____________________________________________
Daytime Phone :________________________________________ Method of Payment : Check or Money Order payable to National Headache Foundation ❒ Visa ❒ MasterCard ❒ Amex ❒ Discover
Card #: _____________________ Expiration Date : ___________
New Membership | Toll-Free ( 888 ) NHF-5552 | www . headaches . org
Individual Membership : Payment :
� $ 20.00 to receive HeadWise ® plus the monthly e-newsletter , NHF News to Know , when you join the National Headache Foundation
In addition , I ’ d like to make a tax-deductible contribution in support of NHF ’ s educational programs in the amount of : � $ 10 � $ 25 � $ 50 � Other : $_____
_______________________________________________________________ Name ( Please Print )
_______________________________________________________________ Address
_______________________________________________________________ City / State / Zip / Country
_______________________________________________________________ Preferred Phone #
E-mail Address
� Payment enclosed ( check payable to National Headache Foundation )
Charge to my credit card : � Amex � Discover � Mastercard � Visa
___________________________________________________________ Credit Card Number
Expiration Date
___________________________________________________________ Cardholder ’ s Signature
___________________________________________________________ Billing Address ( If different from mailing address )
___________________________________________________________ City / State / Zip / Country
Please mail this form with your payment to : National Headache Foundation , 820 N . Orleans , Ste . 411 , Chicago , IL 60610 or renew online by visting www . headaches . org
www . headaches . org | National Headache Foundation 9