NAF Contribution Form

Neuropathy Action Foundation

Donation Form

Thank you for making a tax-deductible contribution to NAF.

First Name *

Middle

Last Name *

Company / Organization

Address *

City *

Zip/Postal Code *

State *

Country *

Email Address: *

Phone 🛈

What type of Neuropathy are you or your family member diagnosed with?

I am interested in learning more about neuropathy because:

Donation level:

Other donation amount: *

Optional: In dedication to or in memorial of (please state which and give full name):

Personal information or notes:

Please add me to the NAF "Patient Voice" newsletter sent via email monthly.

Yes

No

Click "Continue" button below to review your donation and payment options.

All Funds go to the Neuropathy Action Foundation (NAF). NAF is a 501(c)(3) non profit, is dedicated to ensuring neuropathy patients obtain the necessary resources, information and tools to access individualized treatment to improve their quality of life.

For your records, our Tax identification Number is 20-4792248.

NEED HELP: Please call or email us at (877) 512-7262 (info@neuropathyaction.org) for assistance. Thank you.

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NAF Donation - Other Amount