Disability Rights Education & Defense Fund Donation Form

Please print this page and, after filling it out, mail it to:

Disability Rights Education & Defense Fund
3075 Adeline Street, Suite 210
Berkeley, CA 94703

I believe that individuals with disabilities have the right to an education, transportation, housing, and access to public services as well as the right to lead independent, dignified, and enjoyable lives. I want to make a difference to ensure that people with disabilities continue to have these rights.

Here is my tax-deductible gift to DREDF in the amount of $__________.

I’d like to make a recurring donation in the amount of $__________ every month/quarter. (Please circle one.)

Name (As on credit card, if applicable): _________________________________________________
Address: ________________________________________________________
City: ________________________________ State: ____ Zip: _______________
Phone: __________________________ Email: ______________________________

About your contribution:
_____ My check payable to DREDF is enclosed.
_____ Please charge my: MasterCard Visa American Express

Card No. _______________________________________________
exp. date ______________________________________________
3-digit security code __________________________________
Billing zip code _______________________________________
Signature ______________________________________________

Gifts made in recognition:
_____ In Honor ____ Memory of ___________________________________________

Please send a gift notification to:
Name: __________________________________________________________
Address: _______________________________________________________
City: ________________________________ State: ____ Zip: ___________

Thank you!