The Transverse Myelitis Association is a 501(c)(3) not-for-profit organization dedicated to support, education and research for neuroimmunologic disorders of the central nervous system, which include: Transverse Myelitis, Acute Disseminated Encephalomyelitis (ADEM), Optic Neuritis, and Neuromyelitis Optica (Devic's disease).

Please mail this printed form and your contribution to:

The Transverse Myelitis Association
1787 Sutter Parkway
Powell OH 43065-8806

Make checks payable to: The Transverse Myelitis Association

All donations will be acknowledged in writing. Donations are tax-deductible to the fullest extent allowed by law.
Our employer ID number is 91-1780467.

Enclosed is a check for $____________
Name:
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Address:
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City:
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Country:
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Phone:
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Email:
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Charitable Donation Categories
Individual/Family
$25
Sustainer
$50
Contributor
$100
Sponsor
$250
Patron
$500
Benefactor
$1000
TMA Trustee
$2500
Other $_______________

Company Matching Donation: (Optional)
Increase your gift! Check with your company's human resource department to inquire about a matching gift program. Send the completed matching gift form to TMA along with your donation, and we'll take care of the rest!

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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.

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This Gift is Made: (Optional)

In honor of: ____________________________________________________________________________________________

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In memory of: __________________________________________________________________________________________

Please send acknowledgment to:

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