Donating to GIST Support International by Check

Please fill out and print this page to mail with your check, or write the information on a note to enclose with your check.

We need your name and address to mail you a receipt acknowledging your tax-deductible donation.

Your name: ___________________________________________
Your address:
(street or box) _________________________________________

(town)  ______________________________________________

(state or province, postal or zip code) _____________

(country) ___________

Which fund do you wish to contribute to?
_____ General fund
_____ Bob Spiegel and Brad Clark Second Opinion Fund
_____ Healing Through Music

If your gift is a memorial donation, please provide the name and address of the family of the deceased so that we can tell them about your gift.

Memorial gift for __________________________________________

Family mailing address:

__________________________________

__________________________________

Please mail your check to
GIST Support International
12 Bomaca Drive
Doylestown, PA 18901