Membership and Renewal Form

Please accept my tax-deductible contribution for the following membership category.

$20 - Individual

$50 - Donor

$1000 - Patron

$100 - Sponsor

I wish to join but cannot afford to pay at this time.

Please send me more information about Lupus

I would like to make a tax-deductible contribution in the amount of:

$

Name:

Address:

City

Credit Card Information:

CC Type

Mastercard Visa Discover

Credit Card #

Expiration Date

Name:

Address:

City

Membership in the LFA, South Central Texas Chapter, Inc., A Chapter of the Lupus Foundation of America Inc.  Automatically insures membership in our national organization.  All financial contributions are acknowledged and are tax deductible.

If paying by credit card, please fill in form, print and fax to number below.  Mail payment to:

LFA-South Central Texas Chapter

5503 Grissom Road, Suite 101

San Antonio, TEXAS 78238

210.615.9480 (voice)

210.767.8626 (fax)