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LDA Donation Form
All donations are fully tax deductible.

* Required Fields
Donor information
Donation purpose*
First name*
Last name*
Organization
Address*
City*
State*
Zip*
Country*
Phone
Email*
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Donation Information
Amount Tooltip $10.00
$25.00
$50.00
$100.00
$
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You can proceed to the "NEXT" (bottom left) if you are not making a specific type of donation as listed below.
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In honor of/ In memory of :
Donation Type
Name of person to recognize
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Please acknowledge my donation to:
Title
Full Name
Address
City
State
Zip
Country
Phone
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Contact Us

Lyme Disease Association, Inc.
PO Box 1438, Jackson, NJ 08527
888-366-6611 |  information line
732-938-7215 |  fax
LDA@LymeDiseaseAssociation.org | email