Friends of the NIDL FORM

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Yes, I want to help support N.I.D.L. with a financial contribution as a Friend!

NAME                                                                                           

ADDRESS                                                                                     

CITY                                                STATE             ZIP                 

E-MAIL                                                                                         

FOR PROFESSIONALS

BUSINESS NAME                                                                           

BUSINESS E-MAIL*                                                                       

*If e-mail is different from personal

BUSINESS PHONE                                                                          

AMOUNT OF SUPPORT

[ ] $25   [ ] $50   [ ] $75   [ ] $100   [ ] Other                   

IF BY PAYPAL PLEASE ADD THE DATE OF TRANSACTION     /     /    

[  ] YES, Please contact me on all events and speakers that NIDL supports.

Your contributions may be tax deductible.