The Transverse Myelitis Association is a not-for-profit organization dedicated to support, education and research for a cure to neuroimmunologic disorders of the central nervous system, which include, Transverse Myelitis, Acute Disseminated Encephalomyelitis (ADEM), Optic Neuritis, and Neuromyelitis Optica (Devic's disease).

If you would like to send a donation to help our efforts, simply print out the form on your printer, fill it out, put it in an envelope with your donation and send it to:

The Transverse Myelitis Association
Paula Lazzeri, Treasurer
10105 167th PL NE
Redmond, WA 98052-3125

Thank you for your support!

Yes, I support The Transverse Myelitis Association!
Enclosed is a check for $____________
Name:
 ________________________________________________________
Address:
 ________________________________________________________
City:
 ________________________________________________________
State
 ________________________________________________________
Zip Code:
 ________________________________________________________
Phone:
 ________________________________________________________
Email:
 ________________________________________________________
Charitable Donation Categories
Individual/Family
$25
Sustainer
$50
Contributor
$100
Sponsor
$250
Patron
$500
Benefactor
$1000
TMA Trustee
$2500
Other $_______________

Company Matching Donation (Optional)
You may be able to double or even triple your contribution to the TMA if you work for a company that matches employee gifts. Even companies without formal programs will often provide contributions to charitable organizations in which employees are involved.

_________________________________________________________________________________________________________
Designation (Optional)
To designate your donation for a specific fund or purpose, please enter a description of how you'd like your donation to be used.

_________________________________________________________________________________________________________
This gift is made (Optional):

In honor of: ____________________________________________________________________________________________

On the occasion of: ______________________________________________________________________________________

In memory of: __________________________________________________________________________________________

Please send acknowledgment to:

Name: _________________________________________________________________________________________________

Address: _______________________________________________________________________________________________