Gifts of Love to Transplant Central
(To print this form only, click on the text and then use your normal print options)

Please print and use this form for contributions, memorial gifts, or for honoring your friends and family on special occasions.

Once completed, mail this form and gift to:

LATV
PMB 165, 590 West Main Street
Santa Paula, CA 93060

Please accept my tax deductible contribution of $___________
___ Check Enclosed (Please make payable to LATV. )
___ VISA or ___ MasterCard
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| exp. ___/___
All contributions are tax-deductible as allowed by law.
Your Name: ___________________________________________________________
Address: _____________________________________________________________
City: ____________________________ State __________ Zip __________
E-mail Address: _____________________________________________ (To be held in privacy)
My gift is made:
In Memory of: _________________________________________________________
In Honor of: _________________________ for the occasion of ________
__________________________________________________________

Please Notify :

Name _____________________________________________
Address ___________________________________________
City_____________________________State____________Zip__________
|___| I've enclosed a picture, and statement of sentiment and support for the people who share their personal experiences so that other lives may be enriched. You have my permission to include these on your website.
...We thank you for your generosity...