Please print out this page and send it with your donation to
JJAMD
Forsyth Research Institute
140 Fenway
Boston, MA 02115-3799
"JJAMD has improved the quality of for me and my family - at last I'm not alone or being misjudged for my pain and dysfunction."
Since 1982 JJAMD has assisted thousands of people through seminars, support groups, lectures, publications and personal contacts. Your support will help us continue to help others.
NAME___________________________________________________
ADDRESS______________________________________________
CITY_______________________STATE____________ZIP____________
TEL: (Home) (_____)____________(Bus.) (_____)____________
Please check one box:
Full membership ($20) |
| TMJ patient | |
Professional member ($40) | Relationship to TMJ patient | ||
Friend ($100) | Professional | ||
Patron ($500) | Field: _______________________ | ||
Sponsor ($1,000 and up) |
|
| |
Donation ($ other amount) |
|
|
Please make checks payable to JJAMD Foundation, Inc.
All donations tax deductible as a 501 (c) 3 organization.