MIMA Foundation
Pay-by-Check Donation Form

I am making a gift of:

___ $20     ___ $30     ___ $50     ___ $100     ___ $ 200     ___ $500     ___ $1,000

or $ ___________ (Please indicate amount.)

Please fill in your name and address below to ensure the correct preparation of your receipt for tax purposes:

Please make your check payable to MIMA Foundation.

This form should be sent to:

MIMA Foundation
P.O. Box 7133
Jupiter, FL 33468-7133

Thank you for your generosity. All contributions are tax-deductible in the U.S.
Unless otherwise noted, your gift will be used by MIMA Foundation for the project(s) that MIMA Foundation determines is (are) in need of funds.

MIMA Foundation is recognized as tax exempt under section 501(c)(3) of the Internal Revenue Code. Annual Reports are available upon request.

Web address: http://www.mimafoundation.com
Phone: 561-747-3334
FAX: 561-747-2535