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ONLINE DONATION FORM

If you prefer to send your donation by postal mail, click here to access a print-version of our contribution form.

Please indicate the amount you wish to donate next to the fund or activities you wish to support:

Fund Gift Amount
General Fund (Unrestricted Gift) $
2008 Scholarship Campaign $
Research Support $
Advocacy $
   
Mailing Address: Please provide your mailing address to receive a written receipt. 
First Name*
Last Name*
Address*
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Outside North America - Choose 'Unlisted' from the drop-down menu
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Country*
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Are you a member of the Academy for Eating Disorders?
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No
   
If applicable, please indicate the following:
My gift is in honor of

Please send an acknowledgement card to:
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Please contact me regarding:
Other forms of giving (stocks, securities, insurance, matching funds, etc.)
   
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Expiration Date* Month Year
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Outside North America - Choose 'Unlisted' from the drop-down menu
Billing Postal Code*
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