Donation Form

The economy is incredibly tight, but AIDS is still with us.

Over 4,000 friends were mailed and asked to give in the $25 Campaign. The math is simple -
if everyone gives $25 . . . what a difference it will make.

Your gift (in any amount) in direct support of APM’s programs and services is always
needed and welcome!

Please click on one of the gift level below, or enter any other gift amount in the
“other gift” field, no punctuation in the amount, the decimal is ok,
then enter your name and address information.

I/We wish to contribute the following

Amount:
	THAT’S AN INVESTMENT I WILL MAKE!	$25
	Other	$

This contribution is by a business or organization.

Please do not publish my name as a donor.

Donor Information

Please complete all fields with a red heading. Use the other fields as necessary.

(If you intend to use a credit card for this contribution, please give your name and address as it appears on
the credit card bill.)

Title
First Name
Initial
Last Name
Company Name (if a business address)
Address 1
Address 2
City
Country
State
Postal Code
Telephone	- - ext.
Fax	- -
Email Address
(AIDS Partnership Michigan does not share any personal information with anyone.)

If using a credit card, you will enter your account information on a separate, secure page.

Select a Payment Method

Matching Gifts

My company will match my gift

Tribute - This gift is made

in memory of
in honor of

Comments:

Please click “Continue” to verify the information you entered above.