Use the form below to reserve and pay for your page.
Design your submission
Full page: 4 1/2 x 7 inches
Half page: 4 1/2 x 3 1/2 inches
Quarter page: 4 1/2 x 1 3/4
Fill in & submit the Journal form
for our Journal form
Fax, email or mail the form
Fax, email or mail your artwork
Pay below with credit card
Mail a check
Call us with your credit card
Outside Back - $18,000
Inside Front - $15,000
Inside Back - $10,000
Diamond Page - $7,500
Jewel Page - $5,000
Gold Page - $2,500
Silver Page - $1,000
Bronze Page - $500
Full Page - $400
Half Page - $250
Quarter Page - $125
Booster Listing (Name Only) - $36
If you want to pay for your Journal page online, fill in your payment
and click the "Contribute" button;
you will be
transferred to a secure web site
enter your credit card details.
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
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
New York, NY 10018