I would like to be a COPD Resource Network National Partner. Please use my gift/grant as I have indicated below.

Please provide the following contact information:

First Name
Last Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
E-mail
Please enter the amount of your Individual gift or grant and the specific project, or as an unrestricted educational grant, in the boxes below:
Amount:
Purpose:

Please print the form, fill it out and mail with
your check made out to NECA

Send form and check to the following address: 

COPD Resource Network Membership
2425 Ridgecrest Dr. SE
Albuquerque, NM 87108-5127

NECA is a 501 3c not-for-profit corporation and donations are tax deductable.

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Last modified: 07/19/04