Center For Neurologic Study 
A Center dedicated to bettering the lives of the neurologically ill through research and compassionate care 

Your Name?________________________________ E-mail address?____________________________________

Yes, I want to advance the cause of research and treatment of crippling neurologic diseases.
Choose one:
( ) $5000                   ( ) $100
( ) $1000                   ( ) $50
( ) $500                    ( ) $25
( ) $250                    ( ) Other $_____________
 
My gift should be used ...

( ) For          _______________________________________________

( ) In honor of  _______________________________________________

( ) In memory of _______________________________________________

Name of Contributor(s):_________________________________________

Address & Zip:__________________________________________________

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Your gift supports the work underway at the CENTER FOR NEUROLOGIC STUDY - 
Developing new treatments for Amyorophic Lateral Sclerosis (ALS), Multiple Sclerosis, 
Alzheimer's and related diseases. 

( ) I would like to receive more information about CNS' programs. 
( ) I would like to receive information on estate planning. 

Please make your tax-deductible contribution payable to: 

CENTER FOR NEUROLOGIC STUDY