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BIANH Gifts Program

This program allows you to help fund programs for brain injury survivors and their families, and safety and prevention programs in New Hampshire, while marking a special occasion or remembering someone special.  Gifts can be made for birthdays, engagements, anniversaries, graduations, promotions or retirement.  Family members or friends will be notified of your thoughtful contribution and amounts are always kept confidential.
Please print, complete and submit the following form.
 
Please accept my contribution of $________________________
In Memory or In Honor Of      (please circle one)
For _______________________________________ (occasion)
Name _____________________________________
Address ___________________________________
City _______________________  State ______  Zip _________
 
Please notify the following of my contribution
Name _____________________________________
Address ___________________________________
City ________________________ Stae _______  Zip _________
____ Enclosed is a check payable to the Brain Injury Association of NH
____ Please charge my:  ____ VISA  ____Mastercard
Card# ________________________________ Exp. Date: ______________
 
Please print the following form and submit to:
Brain Injury Association of NH
109 North State St.
Concord, NH 03301
 
To translate please click on the following flag links:        
© 2008 - 1998 Brain Injury Association of New Hampshire
The Brain Injury Association of New Hampshire does not support, endorse, or recommend any product, method of treatment, or program for persons with brain injury. We endeavor to inform and believe that you have the right to know what help is available. Information within these pages consists of items that may be of interest to our community.