AMERICAN IRIS SOCIETY FOUNDATION DONATION FORM DATE ________________ DONATION FROM: Name______________________________________________________ Address____________________________________________________ City,State,Zip________________________________________________ Phone:___________________ EMAIL:____________________________ IN MEMORY OF _____________________________________________________________ IN HONOR OF _______________________________________________________________ OR GIFT______ AMOUNT____________ Funds to be deposited into: AIS FUND _______ OR AIS FOUNDATION FUND_________ Acknowledgment to be sent to: Name__________________________________________ Address________________________________________ City,State,Zip____________________________________ PAY BY PAYPAL? YES______ NO___ PLEASE CHARGE THE FOLLOWING CREDIT CARD: Name_____________________________________ Type of Card: VISA MC Disc AMEX Card #____________________________________ Exp Date Mo___ Yr _____CVS______ Mail Form and/or check (made out to AIS Foundation) to Jill Bonino, AIS Foundation, 3110 Kirkham Drive, Glendale, CA 91206