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Donation Form
YES, I believe in preserving the dignity
of individuals diagnosed with terminal illness! Please accept
my donation to the Life With Dignity Foundation to help
improve the quality of life for people facing the end of life.
Friend: ($25 - $50)
Family: ($51 - 100)
Patron: ($101 - 149)
Benefactor: ($150 & Over)
Your Name:
Address:
City/State/ZIP Code:
Phone:
E-Mail:
Please make checks payable to:
Life With Dignity Foundation
Print this form and mail to:
Life With Dignity Foundation
1744 Riggs Place, NW, #300
Washington, DC 20009
Phone: 202-986-0118
Donations to the Life With Dignity
Foundation are tax deductible.
Return to
Life with Dignity Home Page
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