ACLM FOUNDATION DONOR FORM

ACLM Foundation Corner

The ACLM Foundation is proud to offer the membership of ACLM a way to honor, memorialize, or wish a speedy recovery to friends, relatives and fellow members while contributing to the educational goals of ACLM. Each contribution will be acknowledged to both the honoree and donor, and hopefully will become a regular listing in Notes from the President. Such contributions are considered tax deductible by the IRS and will go to finance such projects as the National Health Law Moot Court Competition at Southern Illinois University School of Law, Annual Meeting speakers, Legal Medicine and Bioethics writing contests, and Textbook awards to outstanding medical and law school students. The donation form may be printed out and mailed to the ACLM office (Attn: ACLM Foundation) at the address below. Let us make this a growing part of ACLM's collegial life.

AMOUNT (please circle)
$25
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$1,000
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$10,000
$____________
(Other amount)

ACLM FOUNDATION DONATION FORM

(Please type or print)

ACLM Foundation
1100 E. Woodfield Rd., Suite 520
Schaumburg, IL 60173
Phone: (847) 969-0283 Fax: (847) 517-7229

This gift is being made

In Honor of: _______________________________ for _________________________________.

(Specify Reason)

In Memory of: __________________________________________________________________.

To Wish: ______________________________________________________ a speedy recovery.

No acknowledgment is necessary.

Please send an acknowledgment (amount not disclosed) to the above individual or
family of the deceased, at the address below.

ACKNOWLEDGMENT TO:

Name:________________________________________

Address:______________________________________

City, State, Zip: _________________________________

DONOR:

Name:________________________________________

Address:______________________________________

City, State, Zip: _________________________________

Thank you for your donation!

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