Picture of Health Foundation

Yes, I want to become a Longevity Society Member and make a difference in the health and well-being of our community by supporting the future of the Picture of Health Foundation, Inc. All donations to the Picture of Health Foundation, Inc. are tax-deductible

Membership Levels:

	Silver Sponsor of the Picture of Health Foundation, Inc. ($1, 000 – $1,998)
	Gold Sponsor of the Picture of Health Foundation, Inc. ($1, 999 - $9,999)
	Platinum Sponsor of the Picture of Health Foundation, Inc. ($10,000 or more)

	I want to make a three year gift. My promise is $ per year, totaling $ over three years. A payment of $ is enclosed.
	I want to give, but would like to make an annual gift. My gift in the amount of $ is enclosed.

I prefer to make my gift in:
	Annual installment (s)
	Semi-annual installments
	Monthly installments
My E-Mail Address