CONNECTICUT LIONS EYE RESEARCH FOUNDATION, INC.

THE MEMORIAL PROGRAM

Your Memorial Gift is a thoughtful gift of lasting value. Through it, you honor the memory of a friend, relative, or associate … and also provide a service for the living through Eye Research.

A card with the gift amount will be sent to you acknowledging your tax deductible donation. The family of the deceased will also be notified.

Please fill out the material below:  

Enclosed is a Memorial Gift in the amount of $ ____________  


In Memory of (Name): ______________________________________________________


Please send memorial acknowledgement to:

Name:    __________________________________________________________________

Address: __________________________________________________________________

City:    ______________________________ State: __________  Zip:____________


From:

Name:    __________________________________________________________________

Address: __________________________________________________________________

City:    ______________________________ State: __________  Zip:____________

Please make your tax deductible check payable to: The Connecticut Lions Eye Research Foundation, Inc.

And mail it with this form to:

CT Lions Eye Research Foundation, P. O. Box 9268, New Haven, CT 06533

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