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Donate to American Foundation for Cardiomyopathy

http://www.americanffc.org

Thank you for considering a tax deductible monetary gift to the American Foundation for Cardiomyopathy. As appreciation for your donation, a gift will be sent to you.

Gift Chart
Under $250	$251 -$500	$501 - $1000	$1001 - $2500	$2501 +	$10,000 +
Lapel Pin	Pin and Lunch Bag	Pin and Tote Bag	Pin and T-Shirt	Pin and Water Bottle	Pin and Diamond Award

Donations may also be made by mail by using this form.

Contribution Amount

$25
$50
$100
$250

$500
$1,000
$2,500
$

Personal Information

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Employment Information

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Payment Information

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Billing Information

Same as home address.
Billing Address
Billing Address (line 2)
City
State
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Contribution Type

Make this monthly recurring contribution

for

I want to publish my name to the Donate to American Foundation for Cardiomyopathy giving stream! (Note: your contribution amount will not be shown)

Your donation will appear on your credit card or bank statement as "RALLY/PIRYX"

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The American Foundation for Cardiomyopathy is a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code, DONATIONS ARE TAX DEDUCTIBLE.

American Foundation for Cardiomyopathy, 4802 East Ray Road, Suite 23527, Phoenix, AZ 85044. 1-800-433-0774.

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