CONNECTICUT LIONS EYE RESEARCH FOUNDATION, INC.

Post Office Box 9268 New Haven, CT 06533 Telephone (203) 785-6121

THE RECOGNITION PROGRAM

As a service to you, your family, club, business, or organization, you or other donors may make a gift donation to the CONNECTICUT LIONS EYE RESEARCH FOUNDATION, INC. which recognizes a birthday, anniversary, special event or extends get well wishes to a friend, relative, or associate. Your gift provides a service through Eye Research when you use this Foundation Recognition Program.

A beautiful card, acknowledging your thoughtful gift, with an appropriate inscription will be sent to the recipient being recognized conveying your kind sentiments. If you would like, enclose a picture to be used on the card.

A response notice is always sent to the donor acknowledging the gift amount for tax deductible purposes.  

Enclosed is a donation      $ ____________  Date of occasion: _____________
in the amount of: 

Please check appropriate recognition card choice:

To celebrate the birthday of  _____________________________________________
(Name): 

To extend anniversary         _____________________________________________
congratulations (Names):

To congratulate on a special  _____________________________________________
occasion (Name):

     (Occasion):              _____________________________________________


To extend get well wishes     _____________________________________________
(Name):

Other:   __________________________________________________________________

Please send Recognition Card 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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