Contribution Form
Thank you for contributing to Donate Life North Carolina (DLNC). Our mission is to inspire all North Carolina residents to save and enhance lives by registering as organ, eye, and tissue donor. Your gift will help us provide much needed public education to the Division of Motor Vehicles, ad schools via the media and other venues. DLNC is a 501(c)(3) non-profit organization and your contribution is tax-deductible.
Please print, complete and mail this form to the address below and an acknowledgement letter will be mailed to you for your records. Please make checks payable to Donate Life North Carolina. Thank you for your generous gift.
Name___________________________________________________________________________
Organization____________________________________________________________________
Address_________________________________________________________________________
City, State, Zip___________________________________________________________________
Phone Number__________________________________________________________________
Email___________________________________________________________________________
Amount Enclosed: ______________________________________________________________
If applicable, please select one: □ In Memory of □ In Honor Of
If this gift is in memory/honor of someone, we would be glad to send a card informing them or their family of your thoughtful gift, without an amount indicated.
Name__________________________________________________________________________
Address________________________________________________________________________
City, State, Zip___________________________________________________________________
Thank you again for your support!
Donate Life North Carolina
4750 Commercial Park Court, Clemmons, NC 27012
DonateLifeNC.org
EIN 01-0659217