Decorate for aCure
The gift that keeps giving!
This holida y season, the Alpha -1 Founda tion ha s pa rtne red with South Florida
businesses such a s loca l a rtist, Gene Za re sk owne r of Elements of Color and
Juan Ca rlos Corone t of European Pe t Groom ing, Bodhi F. & Dashi C hu Kocica at The Hoshino Therapy C linic of
Miami, Village Montessori School and 88.9FM WDNA Radio Station.
He lp fund a cure for Alpha -1 Antitrypsin De ficie ncy (Alpha -1).
De cora te your home with a tree filled with unique ly designed tropica l ornaments.
Please select one of the following:
Item #’s
Q ty: ___ Red Tag O rnaments
$10.00
Q ty: ___ Yellow Tag O rnaments
$15.00
Q ty: ___ Green Tag O rnaments
$20.00
Q ty: ___ Blue Tag Ornaments
$25.00
Your gift is tax
deductible
(amount will be
given on
a cknowle dgement
and ma iled to
address provided
be low.
Sea weed Ga rla nd (a va ila ble upon request)
$____________
Additiona l Dona tion in Support of Resea rch
$____________
Total $_________
In the spaces provided, please print your name, address, telephone, and email.
Name /Co.:
__________________________________________________________________
Address: ______________________________________________________________________
C ity: ________________________________
Sta te: ______
Zip: ________________________________
Te lephone: ____________________________
Alt. Te lephone : _______________________
Ema il Address: _________________________
If you do not want your name added to our mailing list (check here)
Payment Options: Plea se se le ct from the following pa yment me thods.
Ame rican Express
Maste r Ca rd
Gift Amount: ______________
Visa
Che ck
Cash
Gift Da te : ___________
Please make check payable to:
Alpha-1 Foundation
Account No.: _______________________________
Expiration Da te: ______________________
Name on Ca rd: _____________________________
Zip Code of Ca rd: _____________________
Signa ture: _________________________________
For more information or ques tions please call M ichelle D . Naples at the
Alpha-1 Foundation 2937 SW 27 Avenue, Suite 302
888-825-7421 ext. 248 Fax (305) 567-1317 .
Alpha-1 is a hereditary condition which may result in s erious lung and/or liver dis eas e in infants , children & adults .
About 3% of all people diagnos ed with Chronic Obstructive Pulmonary Dis eas e (COPD) may have Alpha-1.