(Please print this form and mail it with your donation to DYNA. You may also utlize the Justgive.com link on our web site for an easy and efficient way to donate.)
Please accept my donation to:
Dysautonomia Youth Network of America, Inc.
My Name:
My Address:
City, State, Zip:
Country (if outside US):
Telephone:
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Amount Donated:
Contributions can be made to:
Dysautonomia Youth Network of America, Inc.
Debra L. Dominelli, Director
1301 Greengate Ct.
Waldorf, MD 20601
(301) 705-6995
Please make checks out to: DYNA
If I can stop one heart from breaking
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain
Emily Dickinson
