“We make a living by what we get. We make a life by what we give.”
― Winston S. Churchill
DONATE
The information you provide is secure and will not be shared. Your gift is
100% tax-deductible.
To send your gift:
1. Please print and fill out this form.
2. Mail or fax it with your contribution in check to our Cornerstone site:
La Jolla Infectious Disease Institute
6044 Cornerstone Ct W
San Diego, CA 92130
Fax: 858 771-2008
To make a donation online, please click here to continue.
LJIDI
DONATION FORM
Amount of Gift: (U.S. dollars) $50 $100 $250 $500 $1000 other: ________
First Name: _____________________ Last Name:_______________________________
Address: ________________________________________________________________
City: ___________________________ State/Province: ________ Postal: _____________
Country: ____________
Phone: ______________
Email: __________________________
Billing Information (If different from above)
First Name: _____________________ Last Name:_______________________________
Address: __________________________________ City: _________________________
State/Province: ____________ Postal: ____________ Country: ____________________
Payment Information
Your name on card: ____________________________________________
Card Type:
☐ American Express
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Card Number: ___________________________________
Exp Date: (MM/YYYY) ____________ Card Verification Number: __________________
Additional Information
This is a gift given in memory of the signed:
__________________________
[ ] Yes, I have included The La Jolla Infectious Disease Institute in my will or trust as a lasting tribute for a loved one or friend.
[ ] I would like more information on how to make a lasting tribute gift for a loved one or friend in my will or trust.