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.
The practice of asking for donations to a favorite charity in memory of a deceased relative or friend is very thoughtful. A gift may also be given as a tribute in the name of a friend or relative to commemorate significant occasions,
such as birthdays, anniversaries, or special events.
During the past year, such requests have resulted in donations which benefit
the National Headache Foundation. Acknowledgments of memorial gifts and
tributes are mailed to the family or individual. We thank those benefactors and
their families who have supported the NHF and its mission.
Please select one of the following giving categories:
❒ $250
❒ $125
❒ $100
❒ $75
❒ Other _________________
In Memoriam
Name: _______________________________________________
Address: _____________________________________________
Susan Abrams
Lisa Barrett
Joan Davis
Sheree Shelton Duszynski
Mildred GK
Michaelina Ifasi
Marianne Principe Markey
City: _________________________________________________
State/Zip: ____________________________________________
Daytime Phone: ________________________________________
Method of Payment:
Check or Money Order payable to National Headache Foundation
❒ Visa
❒ MasterCard
❒ Amex
❒ Discover
In Tribute
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, Payment enclosed (check payable to National Headache Foundation)
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: $_____
Charge to my credit card: Amex Discover Mastercard
_______________________________________________________________
Name (Please Print)
___________________________________________________________
Credit Card Number
Expiration Date
_______________________________________________________________
Address
___________________________________________________________
Cardholder’s Signature
_______________________________________________________________
City/State/Zip/Country
___________________________________________________________
Billing Address (If different from mailing address)
_______________________________________________________________
Preferred Phone #
E-mail Address
Roger Cady, MD
Seymour Diamond, MD
Julie Fleck
Abby Friedman
Daniel Gaitan, MD
Andrea Gallo
Carter Golden
Robert S. Kunkel, MD
Joey Wilder
Xiaobin Yi, MD
___________________________________________________________
City/State/Zip/Country
Visa
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
34
HeadW ise ®
|
Volume 4, Issue 3 • 2015
www.headaches.org
|
National Headache Foundation
35