Donate

Familial ALS is a rare disease, which makes it difficult to obtain funding for our research. We greatly appreciate any support that you choose to provide.

If you would like to donate, please make your check payable to University of Miami ALS. Please indicate "Dr. Benatar Research" in the memo.

Please print this page, fill out the form and send it with your donation to:

Dr. Michael Benatar’s ALS Research
Attention: Susan Fox Rosellini
University of Miami, Department of Neurology
1120 NW 14th Street, Suite 1300
Miami, FL 33136

Your First and Last Name:	___________________________________________________________
Address:	___________________________________________________________
	___________________________________________________________
City, State, Zip:	___________________________________________________________
Country:	___________________________________________________________
E-mail Address:	___________________________________________________________
Daytime Phone:	___________________________________________________________
Evening Phone:	___________________________________________________________
If you would like this gift to be made in the name of someone special, please provide the following information:
This gift is …	☐ In Memory of ☐ In Honor of
Honoree’s Name:	___________________________________________________________
☐ I would like to have a card sent to the following person informing him/her of this donation:
Name:	___________________________________________________________
Address:	___________________________________________________________
	___________________________________________________________
City, State, Zip:	___________________________________________________________
Country:	___________________________________________________________
From:	___________________________________________________________
	(your name as you would like it to appear on the card)
	☐ Share gift amount in the card
	☐ Do not share gift amount
Thank You!