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Donate By MailPlease print the form below, then fill it out and mail it to us with your tax-deductible gift (US dollars), made payable to the International Longevity Center-USA.About YouName:_____________________________________________ Address: ___________________________________________ City: _______________________________________________ State: ______________________________________________ Zip Code: ___________________________________________ Country: ____________________________________________ Company (optional): ___________________________________ Gift InformationAmount (USD): $ _______________________________________ Pay By Credit CardName on Card: _________________________________________ Card Type: _____________________________________________ Card Number: ___________________________________________ Expiration Date: _________________________________________ Signature: ______________________________________________ Pay By Check or Money OrderMake checks or money orders payable to the International Longevity Center-USA. Mail the completed form to:International Longevity Center - USA
60 East 86th Street New York, New York 10028 USA |
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Phone: +1 212-288-1468 Email: info@ilcusa.org