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Yes! I want to make a tax-deductable gift/pledge as an unrestricted gift for research and treatment at the UCLA CARE Center.


Required fields are indicated with an asterisk (*).
Your contribution is greatly appreciated!
*I would like to make:
  Other $
(Contributions of $500 or more are eligible.)


Personal
Title:
* First name:
  Middle name:
* Last name:
  Suffix:
   I am making this gift as a proxy for my organization/company, which should be recognized as the legal donor
UCLA graduation year(s):

Spouse/Partner
  Name:  
  UCLA graduation year(s):

Joint Gift
* This is a joint gift with
my spouse/partner
:

Contact Information
* Street:
 
U.S. Addresses  
*   City, State, Zip:
Non-U.S. Addresses  
  Non-U.S. City/County
  or Province/Postal Code:
  Country:
* This address is my:
* Home telephone:
Business telephone:

* E-mail address:
* This e-mail is my:

Matching Gift

  My/my spouse's employer will match my gift.
  Company name for matching gifts:
  This company is:
Tribute Gift
Please check this box if you would like to honor a family member, faculty member, business associate, community leader, or other with your contribution.
 
Payment method:
I am the parent of a current UCLA student
  Student name:
  Anticipated graduation year:
I am interested in learning more about how I can include UCLA in my estate plan.
I am interested in learning more about creating a scholarship or fellowship.
This gift is anonymous.
I would like to be added to the monthly emailing list for updates on current research and events.
 
How did you hear about the UCLA CARE Center?:  

Comments: