Mail this donation form to : T.H.E. BRAIN TRUST 459 Broadway, Suite 302 Everett, MA 02149

Donations are tax deductible to the extent of the law.

We are certified 501(c)(3) nonprofit organization. Federal ID # 04-3354358
Our website is www.braintrust.org
Telephone : 1-877-252-8480

Enclosed is my tax-deductible donation to help more services that promote powerful information resources
and a healing exchange for patients, families and professionals.

Checks may be payable to T.H.E. BRAIN TRUST

_____ $25   : provides one month internet service for a volunteer

_____ $50    : provides a packet of info and brochures for distribution to a clinic

_____ $100  : provides us with 8 hours of skilled office support (we really need this!)

_____ $250  : provides a computer or equipment upgrade;" or new brochures

_____ $500  : funds a specialty group for a year

_____ $1000  : provides a conference networking booth

_____ other $_____ : just $1 buys postage! It all adds up!

Please provide your return address below so we may send you acknowledgment and a receipt for your tax records. (Donations are tax-deductible to the extent of law) __________________ __________________ __________________ ___ Please send me your next newsletter. ___ I believe in patient/family empowerment so please send me brochures about online support that I may bring to my local library, medical center, doctor, etc. ___ Please contact me about making automatic monthly credit card contributions. ___ I'll use my United Way or Payroll deduction. ___ My employer will match my gift. ___ I will give some frequent flyer miles. ___ I will organize/help with a fundraiser. ___ I have a lead to a grant maker.			Please indicate my donation is ___ In honour of: __________________ ___ For occasion: __________________ ___ In memory of: __________________ Please notify : (provide address) ________________________________ ________________________________ ________________________________

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