Healthy Within Foundation (Tax ID#74-3069281)
5665 Oberlin Drive Suite 206 San Diego, CA 92121
Telephone: 858-622-0221
Fax: 858- 622-0201

Yes, I want to become a sponsor of the Healthy Within Foundation and support your efforts to promote the education and treatment of eating disorders.

Remember, every contribution helps and it is tax-deductible!

We appreciate your interest in the Healthy Within Foundation -please join us in our mission to prevent eating disorders.

Print this form and mail or fax it to the address/fax listed above. Thank you.

Individual/group donation: $__________

Name: ___________________________________________________

Address:__________________________________________________

City: _____________________________________________________

State:_____________________________________________________

Zip:_______________________________________________________

Daytime Phone number: ___________________________________

Evening phone number: (optional)___________________________________________

Email: (optional)___________________________________________________________

Please charge my visa/mastercard:

Account number: ____________________________________________

Expiration Date: ____________________________________________

Billing Name: _______________________________________________

Billing address: _____________________________________________

Amount to be charged: ______________________________________

Signature: _________________________________________________

_____My check is enclosed. Made payable to the Healthy Within Foundation, Inc.

Mail to:  Healthy Within Foundation Inc., 5665 Oberlin Drive Suite 206 San Diego, CA 92121 

Thank you for joining the fight.............