Dysautonomia Foundation

Dysautonomia Foundation, Inc.
A non-profit organization supporting medical research
and treatment for people with Familial Dysautonomia

Blue Genes Tickets and Raffles

Blue Genes

Cocktail Party / Fashion Show / Auction

Sunday, November 18th 2007

Tickets to Event . . . . . . . . . . . SOLD OUT!

Raffle Tickets . . . . . . . . . . . . . . $100 each
Each raffle ticket gives you a chance to win a stunning 1carat diamond Saint-Tropez pendant necklace valued at over $8,000
You need not be present to win.

After you fill out the form below and click the "Contribute Now" button,
you will be transferred to a secure web site to enter your credit card details.

Event Tickets:	Number of event tickets
Raffle Tickets:	Number of raffle tickets
First Name:
Last Name:
Amount:	$ Total amount of contribution
Mailing Address:	Address 1
	Address 2
City:
State / Zip:
Phone Number:	10 digits only, no ( ) - symbols
eMail Address:
Method of payment:

Please be assured that your transaction is secure and none of your credit card information will be stored in our records. Your privacy is important to us. We will not share your information with any other organization and you will not be added to any third-party mailing lists.

The Dysautonomia Foundation is a registered 501(c)3 non-profit organization.

Dysautonomia Foundation, Inc.
315 West 39th Street, Suite 701
New York, NY 10018
Phone: 212-279-1066
Email: info@familialdysautonomia.org

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