

Neurogel en Marche - USA
Neurogel en Marche - USA
Donation Form
Donation Form
CONTACT INFORMATION:
First Name:
Last Name:
Address: Email:
Telephone:
City: Zip Code:
Your email and address will help us confirm your gift.
Please check one of the following:
___ I am enclosing a check (Dollars only), or money order to: "Neurogel en Marche - USA"
___ I made a PayPal payment online (see Donate button below):
Amount:__________ Date:_________
Please keep in mind that no amount is too small: your donation will be a precious gift that can help bring a cure for paralysis and neurodegenerative diseases to the diverse population worldwide.
Mailing Address:
Neurogel en Marche - USA, Attention Steven Zander, 9420 Holland Avenue, Bethesda, MD 20814
"...To Hope...To Walk...To Live"