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Statement: To comply with IRS regulations, the Angelman Syndrome Foundation receipts all donors of $250 or more.
Financial and other information about The Angelman Syndrome Foundation’s purpose, programs and activities can be obtained by contacting The
Angelman Syndrome Foundation at 75 Executive Dr., Suite 327, Aurora, IL 60504, or for residents of the following states, as stated below. Florida:
SC No. ch4382. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF
CONSUMER SERVICES BY CALLING TOLL-FREE, WITHIN THE STATE, 1-800-HELP-FLA OR VIA THE INTERNET AT WWW.800HELPFLA.COM.
Maryland: For the cost of postage and copying, from the Secretary of State. Michigan: MICS No. Mississippi: The official registration and financial
information of The Angelman Syndrome Foundation may be obtained from the Mississippi Secretary of State’s office by calling 1-888-236-6167.
Nevada: The state of incorporation of Angelman Syndrome Foundation is Florida. New Jersey: INFORMATION FILED WITH THE ATTORNEY
GENERAL CONCERNING THIS CHARITABLE SOLICITATION AND THE PERCENTAGE OF CONTRIBUTIONS RECEIVED BY THE CHARITY DURING
THE LAST REPORTING PERIOD THAT WERE DEDICATED TO THE CHARITABLE PURPOSE MAY BE OBTAINED FROM THE ATTORNEY GENERAL
OF THE STATE OF NEW JERSEY BY CALLING (973) 504-6215 AND IS AVAILABLE ON THE INTERNET AT http://www.state.nj.us/lps/ca/charfrm.htm.
New York: Upon request, from the Attorney General Charities Bureau, 120 Broadway, New York, NY 10271. North Carolina: Financial information
about this organization and a copy of its license are available from the State Solicitation Licensing Branch at 1-888-830-4989 (within North Carolina) or
(919) 807-2214 (outside of North Carolina). Pennsylvania: The official registration and financial information of The Angelman Syndrome Foundation
may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Virginia: From the State Office
of Consumer Affairs in the Department of Agriculture and Consumer Affairs, P.O. Box 1163, Richmond, VA 23218. Washington: From the Secretary of
State at 1-800-332-4483. West Virginia: West Virginia residents may obtain a summary of the registration and financial documents from the Secretary
of State, State Capitol, Charleston, WV 25305. CONTRIBUTIONS ARE DEDUCTIBLE FOR FEDERAL INCOME TAX PURPOSES IN ACCORDANCE
WITH APPLICABLE LAW. REGISTRATION IN A STATE DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION OF THE
ANGELMAN SYNDROME FOUNDATION BY THE STATE.
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Phone: 800-432-6435
International: 630-978-4245
Fax: 630-978-7408
Email: [email protected]
www.angelman.org
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The Angelman Syndrome Foundation (ASF) is
a national 501(c)(3) not-for-profit organization
made up of families, caregivers and medical
professionals who care about those with
Angelman syndrome. Our mission is to advance
the awareness and treatment of Angelman
syndrome through education, information,
research, advocacy and support. Angelman
syndrome (AS) is a neuro-genetic disorder that
occurs in 1 in every 15,000 live births. Individuals
with AS exhibit symptoms such as: developmental
delay; lack of speech; seizures; inappropriate
laughter; and walking and balance disorders.
Angelman Syndrome Foundation, Inc.
75 Executive Drive, Suite 327
Aurora, IL 60504
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DONATION REQUEST FORM
SATURDAY, MAY 16, 2015
The Angelman Syndrome Foundation Walk has been an essential source of
funding for the Angelman Syndrome Foundation since its start in 1999. What
began as a single volunteer walk site, now includes more than 30 walks across
the country and is recognized as the top fundraising event for the organization.
Through education, information, research, advocacy and support, your
participation in the National Walk helps all of us at ASF take strides toward
improving the lives of those impacted by AS. With your help, we are moving
closer to powerful treatments and an eventual cure for Angelman syndrome.
We are continually grateful for the support that we receive year after year.
WHAT’S NEW FOR 2015
New Walk Locations
ASF is thrilled to welcome Eugene, Oregon, International Falls, Minnesota,
Olathe, Kansas and Durham, North Carolina as new Walk sites! This year, a
total of 33 cities will host Walks.
Fundraising Incentive Program
Our Fundraising Incentive Program has changed slightly this year. Prizes
will be awarded cumulatively (i.e., Raise $250 – receive the insulated bag;
Raise $500 – receive both the insulated bag and picnic blanket, etc…).
Read further for complete details.
“Fairly New for 2015”
In 2014 we introduced a new process – the $25 Minimum Online Fundraising
Goal. It was a significant change. You may still have questions. For clarity sake,
we have pulled together some $25 Minimum Online Fundraising Goal FAQs:
Q. W
hy do I have to raise $25 in order to get my shirt and SWAG
bag?
A. We want to see EVERYONE get a t-shirt, bag, water bottle, etc… The
simplest answer we can give is SWAG costs money! This is why the
majority of walk/run races charge an entrance fee.
You may have a question we didn’t address. If so, please contact Kitty
Murphy at Angelman Syndrome Foundation, Inc. –kmurphy@angelman.
org, or 800-432-6435.
WALKERS
Raise Funds – Earn Swag – Have a Picnic!
Fundraising incentive prizes will be awarded to individuals based on the
total amount raised online by a participant by June 15, 2015. Prizes will be
cumulative* (denotes a change from previous years) and will be awarded
to individuals, not teams, for their individual amount raised.
Full Name ❒ Adult
❒ Child
❒ Has AS?
Date of Birth Full Name ❒ Adult
❒ Child
❒ Has AS?
Date of Birth •$250 will receive an Insulated Shopping/picnic bag
•$500 will receive a Hi-Fi Induction Sound Speaker
•$1,000 will receive a picnic blanket
•$2,500 will receive a stainless steel Grill spatula with logo cut into it
•$5,000 will receive a mini grill and cooler set
Full Name ❒ Adult
❒ Child
❒ Has AS?
Date of Birth Full Name ❒ Adult
❒ Child
❒ Has AS?
Date of Birth Full Name ❒ Adult
❒ Child
❒ Has AS?
Date of Birth Full Name ❒ Adult
❒ Child
❒ Has AS?
Date of Birth TEAMS: The top five teams that raise the most money online by April 1,
2015 will be recognized in an upcoming issue of Angelman Today and on
the ASF’s social media channels.
Vendor Fair
We are encouraging all Walk sites to host Free Vendor Fairs. This ‘free’
privilege is specifically for vendors that provide resources or support items
designed for individuals with AS. Vendor examples include government
entities, community organizations, product manufacturers, topical subject
matter experts, and a variety of professionals who are familiar with the
needs of individuals with AS. If you have a suggested vendor who you
feel should participate at your Walk site, contact your local Walk site
coordinator.
Your Donations Support
Funds raised from the Angelman Syndrome Foundation National
Walk support research, educational and informational opportunities,
and support programs and services that enhance the quality of life for
individuals with Angelman syndrome and their families.
Q. W
hat about my child with AS? What about my children under
11 years? What about the volunteers?
A. Children with AS, children under 11 years and all volunteers will receive
a t-shirt and SWAG regardless. This has been and will be our policy for
the foreseeable future.
Home Phone Email Sponsor Name
Street Address
City
State
Zip Code
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Q. What does this mean for groups FUNDRAISING AS A TEAM?
A. Qualifying participants received after the cut-off date are not guaranteed
a t-shirt and SWAG. T-shirts and Swag will be given to ‘late arrivals’ only
while supplies last! A few extras will be ordered based on an educated
estimate, but this cushion will be slim. If your heart is set on a T-shirt, etc…,
please reach your Minimum Online Fundraising Goal early!
City State Zip 6
A. The deadline to be guaranteed a t-shirt and bag is April 20th. Promotional
orders have to be turned in with final numbers in order to get merchandise
to all the sites on time. If we over-order, we waste our constituents’ money.
Q. W
hat if I reach my Minimum Online Fundraising Goal after
April 20th – can I still get a t-shirt and swag?
Address 5
Q. W
hat’s the deadline? And Why do you have one?
A. Fundraising as a team is a new option for 2015 when creating a team.
When you fundraise as a team, the amount your team raises online
by April 20th needs cover $25 for each person on your team in order
for everyone to get a t-shirt. If your team has 10 people, and you have
raised $200 online by April 20th, then your team captain will be given
8 shirts and bags to distribute as they see fit.
Please print. Complete all information for each participant. Please only use one form per address.
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SATURDAY, MAY 16, 2015** – Join us as together
we walk throughout the country!
Alabama (Huntsville)
Arizona (Tempe)
California (Los Angeles)
California (Sacramento)
California (San Diego)
Colorado (Denver)
Connecticut, (Hartford)
Florida (Orlando)
Illinois (Naperville)
Indiana (Indianapolis)
Kansas (Olathe)
Kansas (Wichita)
Louisiana (Breaux Bridge)
Massachusetts (Boston)
Michigan (Rochester Hills)
Minnesota (Hutchinson)
Minnesota (International Falls)
Missouri (Lake of the Ozarks)
Missouri (St. Louis)
Nevada (Las Vegas)
New York (Buffalo)
North Carolina (Durham)
Ohio (Cincinnati)
Oregon (Eugene)
Pennsylvania (Philadelphia)
Pennsylvania (Pittsburgh)
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South Carolina (Columbia)
Tennessee (Nashville)
Texas (Dallas)
Texas (Houston)**
Utah (Salt Lake City)
Washington D.C.
Washington (Seattle)
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**walk held on 5/17/15
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PLEASE CONVERT ALL CASH DONATIONS TO CHECK
Grand Total
Check
Number
Amount
Collected