Donation Form

2751 E Jefferson Ave, Ste 301 Detroit MI 48207
Main Office: 313-446-9800 | www.aidspartnership.org | Hotline: 800-872-AIDS

In the belief that all people have dignity and worth and are entitled to the highest quality of life,
AIDS Partnership Michigan is committed to being an effective and powerfull voice; providing leadership and education;
and providing support services and programs for those infected and/or affected by HIV/AIDS.

Yes, I am committed to the end of AIDS!

I believe in the mission and vision of AIDS Partnership Michigan. My gift will support
the much needed medical case management, prevention & education and behavioral health services.
(Please click on 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:
	Enclosed is my gift of:	$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Please do not publish my name as a donor.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.