The Gerontological Society of America
Donation Form

Fax to GSA at:
(202) 842-1150

or Mail to:
The Gerontological Society of America
Attn: Charles Clary
1030 15th St., NW, Suite 250
Washington, DC 20005

Thank you for making a donation to The Gerontological Society of America! We appreciate your support of GSA's many programs to enhance research, education, and practice in gerontology.

There are three options for submitting your donation:
(1) Print and fax this form with your credit card information to 202-842-1150;
(2) Print and mail this form with credit card information or check made out to "GSA" with "Tax Deductible Contribution" in the memo line; or
(3) Donate online at https://www.geronmembers.org/donate.asp. (The online form accepts payment via Visa or MasterCard only.)

Upon receiving your donation, GSA will mail you a confirmation of your contribution, which may be used for tax filing purposes.

Date: _______________________
Name: ________________________________________________
Address: _________________________________________________________
_________________________________________________________
Donation Amount: _________________

If paying by credit card, please also complete the following information:

Card Type:
Visa
MasterCard
American Express
Diners Club
Card Number: _____________________________________ Exp. Date: ______
Name on Card: __________________________________________
Signature: ______________________________________________

Please use only one method for submitting your donation (fax, mail, or online). If you have any questions, please contact the GSA office at geron@geron.org or 202-842-1275.

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