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| <html> | |
| <head> | |
| <title>Support the Research</title> | |
| <meta name="description" | |
| CONTENT="Support research funded by the Arthritis Nat'l Reseach Foundation."> | |
| <meta name="keywords" | |
| CONTENT="arthritis, research, cure, support, donate, charities, tax-deductable, | |
| funding, grants, education, projects, bequest, contribution, information, treatment"> | |
| </head> | |
| <body bgcolor="#FFFFFF" bgproperties="fixed"> | |
| <div align="center"><center> | |
| <table border="0" cellspacing="0" width="640" style="margin-bottom: 0; padding-bottom: 0"> | |
| <tr> | |
| <td width="12%"><p align="right"><a href="index.htm"><img src="IMAGES/ANR_logo-sm.gif" | |
| alt="Back to Home" border="0" width="80" height="83"></a></td> | |
| <td width="88%"><font color="#400080"><font face="Bookman Old Style" size="5">A</font><font | |
| size="4" face="Bookman Old Style">RTHRITIS </font><font face="Bookman Old Style" size="5">N</font><font | |
| size="4" face="Bookman Old Style">ATIONAL </font><font face="Bookman Old Style" size="5">R</font><font | |
| size="4" face="Bookman Old Style">ESEARCH </font><font face="Bookman Old Style" size="5">F</font><font | |
| size="4" face="Bookman Old Style">OUNDATION<br> | |
| </font></font><font face="Times New Roman" size="3">200 Oceangate, Suite 400, Long Beach, | |
| CA 90802<br>Toll Free: 800-588-CURE (2873).</font></td> | |
| </tr> | |
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| <td width="100%" colspan="2"><font size="4" face="Bookman Old Style" color="#400080">Click | |
| on Logo To Return to Home Page</font></td> | |
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| <table border="0" cellpadding="2" cellspacing="0" width="640" style="padding-top:"> | |
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| <td><p align="left"><img src="Images/helpyou.gif" width="600" height="38"> </td> | |
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| <td><p align="left"><strong><font face="Times New Roman" size="5" color="#400080">Income | |
| Tax Rates are High<br> | |
| </font></strong><font face="Times New Roman" size="4" color="#000000">The higher your tax | |
| rate, the more your charitable deduction is worth in tax savings.</font></p> | |
| <p align="left"><font face="Times New Roman" size="5" color="#400080"><strong>If you own | |
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| </strong></font><font face="Times New Roman" size="4" color="#000000">It usually makes | |
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| <p align="left"><font face="Times New Roman" size="5" color="#400080"><strong>Save those | |
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| </strong></font><font face="Times New Roman" size="4" color="#000000">For all charitable | |
| gifts of $250 or more, the IRS requires you to have one to prove you made a charitable | |
| gift; your cancelled check is no longer sufficient.</font></p> | |
| <p align="left"><font face="Times New Roman" size="5" color="#400080"><strong>Consider a | |
| Lasting and Meaningful Tribute<br> | |
| </strong></font><font face="Times New Roman" size="4" color="#000000">Many of our donors | |
| honor their loved ones with a tribute donation to the Foundation. These gifts may be made | |
| in memory, or in honor of individuals you wish to recognize in a most meaningful and | |
| lasting way.</font></p> | |
| <form method="POST" name="contact" action="maildonate.asp"> | |
| <input type="hidden" name="VTI-GROUP" value="0"><input type="hidden" name="RCPT" | |
| value="anrf@ix.netcom.com"><input type="hidden" name="refer" value="thankyou.htm"><input | |
| type="hidden" name="Subject" value="ANRF CONTACT US INFORMATION"><div align="center"><center><table | |
| border="0" cellspacing="0" width="600"> | |
| <tr> | |
| <td width="100" align="right"><input type="checkbox" name="Donate" value="Yes" | |
| tabindex="1" checked></td> | |
| <td width="100"><b><div align="center"><center><p><img src="Images/yes.gif" width="60" | |
| height="32"></b></td> | |
| <td width="400" colspan="4" align="center"><font face="Times New Roman" size="3"><b>I'd | |
| like to make a gift to support arthritis research.</b></font></td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="100" align="right"><b>Name:</b></td> | |
| <td width="500" colspan="5"><div align="left"><p><b><input type="text" size="35" | |
| maxlength="35" name="name" tabindex="2"></b></td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="100" align="right"><b>Address:</b></td> | |
| <td width="500" colspan="5"><div align="left"><p><b><input type="text" size="35" | |
| maxlength="35" name="Address" tabindex="3"></b></td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="100" align="right"><b>City:</b></td> | |
| <td width="500" colspan="5"><div align="left"><p><b><input type="text" size="35" | |
| maxlength="35" name="City" tabindex="4"></b></td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="100" align="right"><b>State:</b></td> | |
| <td width="100"><div align="left"><p><select name="State" size="1" tabindex="4"> | |
| <option value="AK">AK</option> | |
| <option value="AS">AS</option> | |
| <option value="AS">AS</option> | |
| <option value="AZ">AZ</option> | |
| <option value="AR">AR</option> | |
| <option value="CA">CA</option> | |
| <option value="CO">CO</option> | |
| <option value="CT">CT</option> | |
| <option value="DE">DE</option> | |
| <option value="DC">DC</option> | |
| <option value="FM">FM</option> | |
| <option value="FL">FL</option> | |
| <option value="GA">GA</option> | |
| <option value="GU">GU</option> | |
| <option value="HI">HI</option> | |
| <option value="ID">ID</option> | |
| <option value="IL">IL</option> | |
| <option value="IN">IN</option> | |
| <option value="IA">IA</option> | |
| <option value="KS">KS</option> | |
| <option value="KY">KY</option> | |
| <option value="LA">LA</option> | |
| <option value="ME">ME</option> | |
| <option value="MH">MH</option> | |
| <option value="MD">MD</option> | |
| <option value="MA">MA</option> | |
| <option value="MI">MI</option> | |
| <option value="MN">MN</option> | |
| <option value="MS">MS</option> | |
| <option value="MO">MO</option> | |
| <option value="MT">MT</option> | |
| <option value="NE">NE</option> | |
| <option value="NV">NV</option> | |
| <option value="NH">NH</option> | |
| <option value="NJ">NJ</option> | |
| <option value="NM">NM</option> | |
| <option value="NY">NY</option> | |
| <option value="NC">NC</option> | |
| <option value="ND">ND</option> | |
| <option value="MP">MP</option> | |
| <option value="OH">OH</option> | |
| <option value="OK">OK</option> | |
| <option value="OR">OR</option> | |
| <option value="PW">PW</option> | |
| <option value="PA">PA</option> | |
| <option value="PR">PR</option> | |
| <option value="RI">RI</option> | |
| <option value="SC">SC</option> | |
| <option value="SD">SD</option> | |
| <option value="TN">TN</option> | |
| <option value="TX">TX</option> | |
| <option value="UT">UT</option> | |
| <option value="VT">VT</option> | |
| <option value="VI">VI</option> | |
| <option value="VA">VA</option> | |
| <option value="WA">WA</option> | |
| <option value="WV">WV</option> | |
| <option value="WI">WI</option> | |
| <option value="WY">WY</option> | |
| </select></td> | |
| <td width="100"><div align="right"><p><b>Zip Code:</b></td> | |
| <td width="60" align="right"><div align="left"><p><b><input type="text" size="12" | |
| maxlength="35" name="Zipcode" tabindex="5"></b></td> | |
| <td width="100" align="right"></td> | |
| <td width="100"></td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="100" align="right"><b>Country:</b></td> | |
| <td width="200" colspan="2"><div align="left"><p><b><input type="text" size="12" | |
| maxlength="35" name="Country" tabindex="6" value="USA"></b></td> | |
| <td width="50" align="right"><div align="right"><p><b>Phone:</b></td> | |
| <td width="250" align="left" colspan="2"><div align="left"><input type="text" | |
| size="18" maxlength="35" name="Phone" tabindex="7"></td> | |
| </tr> | |
| </table> | |
| </center></div><div align="center"><center><table border="0" cellspacing="0" width="600"> | |
| <tr> | |
| <td width="200" colspan="2"><b><div align="right"><p>I would like to donate:</b></td> | |
| <td width="100"><b><div align="left"><p><input type="text" size="8" maxlength="35" | |
| name="Amount" tabindex="5" value="$"></b></td> | |
| <td width="100"></td> | |
| <td width="100"></td> | |
| <td width="100"></td> | |
| </tr> | |
| <tr> | |
| <td width="100"><b><div align="right"><p>In honor of:</b></td> | |
| <td width="500" colspan="5"><b><div align="left"><p><input type="text" size="35" | |
| maxlength="35" name="Honorof" tabindex="8"></b></td> | |
| </tr> | |
| <tr> | |
| <td width="100"><b><div align="right"><p>As a:</b></td> | |
| <td width="100"><b><div align="right"><p></b><input type="checkbox" name="memorial" | |
| value="memorial" tabindex="9"></td> | |
| <td width="100"><b><div align="left"><p>Memorial</b></td> | |
| <td width="100"><b><div align="right"><p></b><input type="checkbox" name="tribute" | |
| value="tribute" tabindex="9"></td> | |
| <td width="100"><b><div align="left"><p>Tribute</b></td> | |
| <td width="100"></td> | |
| </tr> | |
| <tr> | |
| <td colspan="6" width="600"> | |
| <p><b><br> | |
| Credit card payment method (MasterCard or Visa only):</b><b> | |
| </b></p> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td width="600"> | |
| <div align="center"><b><img src="Images/sm_mc.gif" width="60" height="38" alt="MasterCard"></b></div> | |
| </td> | |
| <td width="600"> | |
| <div align="center"><b><img src="Images/visa1.gif" width="60" height="38" alt="VISA"></b></div> | |
| </td> | |
| <td colspan="4" width="2400"> | |
| <div align="left"><font color="#400080" size="2" face="Arial, Helvetica, sans-serif"><b>Note</b>- | |
| This is not a secure server. Pay by phone unless you have | |
| a newer browser (3.0+) with built-in security.</font></div> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td colspan="6" width="600"> </td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><input type="checkbox" name="callme" | |
| value="contact by phone" tabindex="10"></td> | |
| <td width="500" colspan="5"><font size="2" face="Courier New"><strong>Please contact me by | |
| phone.</strong></font></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><input type="checkbox" name="online" value="card info below" | |
| tabindex="10"></td> | |
| <td width="500" colspan="5"><font size="2" face="Courier New"><strong>Online.(Recomended | |
| for newer browsers only.)</strong></font></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"></td> | |
| <td width="100"></td> | |
| <td width="100"></td> | |
| <td width="100"></td> | |
| <td width="100"></td> | |
| <td width="100"></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><b>Card type:</b></td> | |
| <td width="200" colspan="2"><select name="cardtype" size="1" tabindex="4"> | |
| <option value="VISA">VISA</option> | |
| <option value="MasterCard">MasterCard</option> | |
| </select></td> | |
| <td width="100"><div align="right"><p><b>Ex. Date:</b></td> | |
| <td width="100"><b><input type="text" size="8" maxlength="35" name="Exdate" tabindex="13" | |
| value="1/00"></b></td> | |
| <td width="100"></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><b>Card number:</b></td> | |
| <td width="300" colspan="3"><b><input type="text" size="20" maxlength="35" | |
| name="cardnumber" tabindex="12"></b></td> | |
| <td width="100"></td> | |
| <td width="100"><div align="left"><p></td> | |
| </tr> | |
| <tr> | |
| <td width="600" align="right" colspan="6"><div align="left"><p><b>Please send | |
| an acknowledgment of this tribute donation to:</b></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><b>Name:</b></td> | |
| <td width="500" align="right" colspan="5"><div align="left"><p><b><input type="text" | |
| size="35" maxlength="35" name="name2" tabindex="14"></b></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><b>Address:</b></td> | |
| <td width="500" align="right" colspan="5"><div align="left"><p><b><input type="text" | |
| size="35" maxlength="35" name="address2" tabindex="15"></b></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><b>City:</b></td> | |
| <td width="200" align="right" colspan="2"><div align="left"><p><b><input type="text" | |
| size="24" maxlength="35" name="city2" tabindex="16"></b></td> | |
| <td width="100" align="right"><b>State:</b></td> | |
| <td width="200" align="right" colspan="2"><div align="left"><p><select name="state2" | |
| size="1" tabindex="4"> | |
| <option value="AK">AK</option> | |
| <option value="AS">AS</option> | |
| <option value="AS">AS</option> | |
| <option value="AZ">AZ</option> | |
| <option value="AR">AR</option> | |
| <option value="CA">CA</option> | |
| <option value="CO">CO</option> | |
| <option value="CT">CT</option> | |
| <option value="DE">DE</option> | |
| <option value="DC">DC</option> | |
| <option value="FM">FM</option> | |
| <option value="FL">FL</option> | |
| <option value="GA">GA</option> | |
| <option value="GU">GU</option> | |
| <option value="HI">HI</option> | |
| <option value="ID">ID</option> | |
| <option value="IL">IL</option> | |
| <option value="IN">IN</option> | |
| <option value="IA">IA</option> | |
| <option value="KS">KS</option> | |
| <option value="KY">KY</option> | |
| <option value="LA">LA</option> | |
| <option value="ME">ME</option> | |
| <option value="MH">MH</option> | |
| <option value="MD">MD</option> | |
| <option value="MA">MA</option> | |
| <option value="MI">MI</option> | |
| <option value="MN">MN</option> | |
| <option value="MS">MS</option> | |
| <option value="MO">MO</option> | |
| <option value="MT">MT</option> | |
| <option value="NE">NE</option> | |
| <option value="NV">NV</option> | |
| <option value="NH">NH</option> | |
| <option value="NJ">NJ</option> | |
| <option value="NM">NM</option> | |
| <option value="NY">NY</option> | |
| <option value="NC">NC</option> | |
| <option value="ND">ND</option> | |
| <option value="MP">MP</option> | |
| <option value="OH">OH</option> | |
| <option value="OK">OK</option> | |
| <option value="OR">OR</option> | |
| <option value="PW">PW</option> | |
| <option value="PA">PA</option> | |
| <option value="PR">PR</option> | |
| <option value="RI">RI</option> | |
| <option value="SC">SC</option> | |
| <option value="SD">SD</option> | |
| <option value="TN">TN</option> | |
| <option value="TX">TX</option> | |
| <option value="UT">UT</option> | |
| <option value="VT">VT</option> | |
| <option value="VI">VI</option> | |
| <option value="VA">VA</option> | |
| <option value="WA">WA</option> | |
| <option value="WV">WV</option> | |
| <option value="WI">WI</option> | |
| <option value="WY">WY</option> | |
| </select></td> | |
| </tr> | |
| <tr> | |
| <td width="100" align="right"><b>Zip Code:</b></td> | |
| <td width="200" align="right" colspan="2"><div align="left"><p><b><input type="text" | |
| size="12" maxlength="35" name="Zipcode2" tabindex="17"></b></td> | |
| <td width="100" align="right"><b>Country:</b></td> | |
| <td width="200" align="right" colspan="2"><div align="left"><p><b><input type="text" | |
| size="12" maxlength="35" name="Country2" tabindex="18" value="USA"></b></td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="100" align="right"></td> | |
| <td width="100" align="right"></td> | |
| <td width="100" align="right"></td> | |
| <td width="100" align="right"></td> | |
| <td width="100" align="right"></td> | |
| <td width="100" align="right"></td> | |
| </tr> | |
| </table> | |
| </center></div><div align="center"><center><p><input type="submit" value="Submit"> <input | |
| type="RESET" value="Clear Form"> </p> | |
| </center></div> | |
| </form> | |
| <p align="center"><font face="Times New Roman" size="3"><strong>You can also print out | |
| this form, fill in the desired information and mail or fax to:<br> | |
| ANRF,</strong> <strong>200 Oceangate, Suite 400, Long Beach, CA 90802</strong></font><br> | |
| <font face="Times New Roman"><strong>Fax: (562) 983-1410<br>Toll Free: 800-588-CURE (2873).</strong></font><br> | |
| </td> | |
| </tr> | |
| <tr align="center"> | |
| <td width="640"><p align="center">Thank you for your support of our efforts to fund this | |
| important research.<br> | |
| Please<a href="contact.htm"> <em><u>Contact Us</u></em></a> for additional information.</p> | |
| <p align="center"><a href="contact.htm"><img src="IMAGES/contact.jpg" border="0" | |
| width="63" height="63"></a></td> | |
| </tr> | |
| </table> | |
| </center></div> | |
| <hr color="#FF0000" width="640" align="center"> | |
| <p align="center"><a href="about.htm">[Meet the ANRF]</a> <a href="whatis.htm">[Latest | |
| Research]</a> <a href="giving.htm">[Support the Research]</a> <a href="donors.htm">[Our | |
| Sponsors]</a> <a href="awards.htm">[Awards]</a><br> | |
| <a href="grant.htm">[Grant Application Guidelines</a> <a href="cureart1.htm">[<em>Cure</em>Arthritis | |
| Newsletter]</a> <a href="useful.htm">[Arthritis Info & Links]</a> <a | |
| href="contact.htm">[Contact Us]</a></p> | |
| <p align="center"><b><font color="#0000FF">This page, and all the contents of this Web | |
| site,<br> | |
| are Copyright © 1999 by TouchVision,<br> | |
| Seal Beach, California. All rights reserved.</font></b> <br> | |
| <font size="2" face="ARIAL,HELVETICA"><b>Best experienced with<br> | |
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