Wednesday, 19 Jan 2022


Florida AIDS Action depends on the community to support its vital work. To continue to address the many complexities of the HIV/AIDS epidemic and related health care issues, your assistance is essential. You can make a contribution to Florida AIDS Action by completing the information below. Your active involvement in our work is crucial. Florida AIDS Action is a 501(c)(3) nonprofit charity as defined by the Internal Revenue Service. Your contribution is tax deductible.

Name: ______________________________________________________
Address: ____________________________________________________
City: ________________________________________________________
State and Zip: ________________________________________________
Day Phone: __________________________________________________
Evening Phone: ______________________________________________
Fax: _______________________________________________________
Email: ______________________________________________________

Your email address will be added to the Florida AIDS Action Broadcast. The Broadcast provides E-News and Alerts, special announcements, and updates. In addition, you will receive faxes and mail from Florida AIDS Action regarding upcoming events, public policy alerts, etc.

Contribution Amount

$25_____ $50_____ $100_____ $250_____ $500_____ $1,000_____ Other _____

Checks should be made payable to: Florida AIDS Action

Membership for organizations is available at various contribution levels and payment plans. Interested corporations and nonprofit agencies and associations should contact Florida AIDS Action at or (813) 232-5886.

Please print and return this form with payment to:

Florida AIDS Action
Administrative Center
P.O. Box 16705
Tampa, Florida 33687-6705

Thank you for your support.