Instructions:
To make a donation, please fill out the form below. Once you have completed the form, please click the "SUBMIT" button to complete the donation process.

If you wish to send your gift via U.S. Mail, you may download this page (31k .pdf), print it and mail it with your check to the address at the bottom of the gift form.
  
 
  Donor First Name
 
  Donor Last Name
 
  Address
 
 
City State   Zip
 

    
  Home Phone
  — —

  Work Phone
  — —

  E-Mail
 


  Payment Method
  
  Pay by credit card or check by filling out the appropriate section below.
 

 
  If Paying By Credit Card
  
  Amount ($)
 
  Card Number
 
  
  Card Expiration Date
  
  Month    Year 
 

 
  If Paying By Check
  
 
Total Pledge Amount enclosed

 

Balance payable:
quarterly semi-annually
annually over years
 
  
If paying by check, please make all checks payable to the Child Neurology Foundation and mail to the address below.
 

 
    
This gift is a tribute in honor of:
 

  This gift is a memorial in honor of:
 

  Please send tribute or memorial acknowledgment to:
 

  at this address
 
 
 


The Child Neurology Foundation is a tax-exempt 501 (c)(3) organization; all donations are tax-deductable under limits of current law.

 






Child Neurology Foundation
2000 West 98th Street
Bloomington, MN 55431

Local: (952) 641-6100
Toll Free: 1-877-236-5430 (1-877-CNF-KID0)
Email: jstone@childneurologyfoundation.org