Print a copy of this form and send it with your gift.

Yes, I would like to make a tax-deductible charitable gift to The Baromedical Research Foundation.
( Federal Tax ID # 57-0859438)

This gift is being given in:

My name _____________________________________________________

In celebration of:

A relative, by the name of ____________________________________________

A friend, by the name of _____________________________________________

My address is:

(Street Address) __________________________________________________________

(City/State/Zip) __________________________________________________________

My Telephone number is: __________________________________________________

My Gift amount is: US $____________________; Foreign Currency________________

Please make your gift payable to:

The Baromedical Research Foundation