Support me as I participate in the  2020 Walk Your Way Fundraiser
Participant’s Name: Margaret Homayoon
Participant’s ID: 114170
Team Name: Default Team
   
  Yes! I will make a contribution to help Alzheimer's Disease Resource Center
   
  $250 $180 $120 $60 $35 Other Amount: $______________________
 
Please Make Your Checks Payable to: Alzheimer's Disease Resource Center
   
Name: ___________________________________________________________________
   
Address: ___________________________________________________________________
       
City: ___________________________ State/Province: ___________________________
   
Zip/Postal Code: ___________________________
   
Country: __________________________
   
Donor Phone: _________________________________________________
   
Email: _________________________________________________________
 
 

Thank You For Your Contribution!

Please Mail this form and check to:

Alzheimer's Disease Resource Center
45 Park Ave.
Bay Shore NY 11706