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I want to advance understanding of the role that spirituality plays in health and well being. Please accept my gift to NIHR in the amount of

______ $500 _______ $250 _________$100 _________$50 __________Other

We are excited that The John Templeton Foundation is matching every new donation by 50%.

Check/Money Order-Payable to NIHR. U.S. banks or draft on U.S. banks only. No foreign currency.
Credit Card - We will contact you at the phone number below for credit card information.
Name as it appears on card __________________________________
Credit Card Number__________________________________
Expiration Date__________________________________
Telephone Number:__________________________________
Please print out this form, fill it out and fax it to:
Pamela Colella
Fax: 301-984-8183
Phone: 1-866-25-ICIHS
*All prices are subject to change without notice.

The National Institute for Healthcare Research is a 501(c)(3) nonprofit organization - donations to which are tax deductible. Please contact your tax advisor for your individual circumstances and current tax laws.

A copy of our current financial statement is available upon request by contacting ICIHS at the above address. Documents and information submitted to the State of Maryland under the Maryland Charitable Solicitations Act are available from the Office of the Secretary of State, State House, Annapolis, MD 21401 for the cost of copying and postage.
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