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15th Anniversary Pledge Form
PXE International 15th Anniversary - $1.5 million in 5 years
Yes!,
I believe we can raise $1.5 million in 5 years to help find a treatment for pseudoxanthoma elasticum (PXE).
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Pledge Information
I want to take a risk that will result in great benefits! I pledge the following amount
over the next 5 years
:
Pledge Type:
*
$25,000 ........ Audacious
$10,000 ........ Heroic
$5,000 .......... Daring
$1,000 .......... Bold
$500 ............. Nervy
$100 ............. Gritty
$50 ............... Plucky
$25 ............... Spunky
Other:
$
Payment Options
Single payment of:
$
Five (5) annual payments of:
$
(2011-2015)
Ten (10) semi-annual payments of:
$
(2011-2015)
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American Express
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Methods of Payment
Your credit card will only be billed for your first payment, we will contact you before any subsequent payments are transacted.
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Expiration Date:
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Last modified: 01/13/2011
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