Printable Donation Form Please print and mail this form to: LUPUS ALLIANCE OF AMERICA LONG ISLAND/QUEENS AFFILIATE 2255 CENTRE AVE BELLMORE,  NEW YORK 11710 Name:   Address:       Phone:       City: State: Zip:           Phone:       Email:         Enclosed is my gift of: $500 $100 $75 $50   Other: $       Memorial/Tribute Gift Name of Honoree:       Gifts of Caring Card: Thinking Of You Thank You   Congratulations Get Well   Send acknowledgement of my gift to: Name:     Address:     City: State: Zip:   Payment Method   Check enclosed payable to Lupus of Long Island / Queens Visa Mastercard   Card Number: Expiration Date: Name on Card:   No receipt is needed for my donation Please keep my gift anonymous and do not include in any publications I have included the Lupus Alliance of America, LI/Q Affiliate in my will Please send me information on Planned Giving All donations are tax-deductible to the extent allowed by law. Lupus of Long Island/Queens is a 501(C)(3) not-for-profit organization incorporated under the State of New York.  A copy of our latest Annual Report may be obtained, upon request, from the Lupus Alliance or from the Office of the Attorney General, Charities Bureau, 120 Broadway, New York, New York 10271.

Please take note that the information contained within this web site is provided for educational and entertainment purposes only. The Lupus Alliance, Long Island/ Queens Chapter is not certified to provide official medical advice or recommendations. We also do not verify the information of sites linked to or from this one and are not responsible for content contained therein. It is recommended that if you have or suspect that you may have lupus or any other medical condition, you consult a certified physician before taking any action.