Donations to APUA APUA gratefully accepts donations towards its goal of promoting the prudent use of antibiotics. Thank you!
Name: Title: Address: Organization: City, State: Telephone: Country: Fax: Zip Code: Email:
Donation amount: $ _____________ If donation is not in US dollars, please specify currency. Donations are tax deductible in the US. ___ Check drawn from a US affiliated bank made payable to APUA ___ International money order made payable to APUA ___ MasterCard ___ Visa Card Number: Expiration:       Signature: Today's Date:       Mail or fax completed donation form to: APUA 75 Kneeland Street Boston, MA 02111-1901 USA Fax: 617-636-3999 www.apua.org
ALLIANCE FOR THE PRUDENT USE OF ANTIBIOTICS © 1999