Supporting the Mission gift of life foundation...This spring, the board adopted a new mission (The...

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GIFT OF LIFE FOUNDATION ANNUAL REPORT | 2013 Supporting the Mission of Gift of Life Michigan Helping Hands Team Building Healing Lives

Transcript of Supporting the Mission gift of life foundation...This spring, the board adopted a new mission (The...

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gift of life foundationANNUAL REPORT | 2013

Supporting the Mission of Gift of Life Michigan

Helping Hands Team BuildingHealing Lives

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In the past year, Gift of Life Michigan has moved forward with major initiatives that should further our mission of saving and improving more lives through transplantation. Much behind-the-scenes work has put us on the verge of launching some truly exciting projects. Highlights include:• GiftofLifeispoisedtobecomethefirstorganprocurementorganizationinthenationtouse“ExVivo”

lung reconditioning. The device will allow recovered lungs to be medically sustained outside of the donor’s body while being readied for transplant. The reconditioning can turn marginal lungs into good lungs and improve the outcomes for the patients who desperately need these gifts.

• ThePeaceofMindRegistry,anonlineadvanceddirectivedepositorywherepeoplecanstoretheirend-of-life decisions. Gift of Life – with the generous assistance of a Gift of Life Foundation grant – has paid for and developed the technology to operate the registry under contract with the Michigan Department of Community Health.

• AplantocreateanewsurgicalcenteratourAnnArborheadquarters.Thesurgicalcenter,whichwasgiven the green light by the Gift of Life Governing Board this past summer, should reduce the time familieshavetowaitforadonationtotakeplaceandboosttheefficiencyoftheprocess,leadingtosmoother recoveries and safer transplants.

Iamalsopleased tosay thatGiftofLifealsohasachievedsignificantaccomplishments inourpublicoutreach. A record 524,000 people joined the Donor Registry in 2012. In addition, we and other donation andtransplantationsupportersrecentlyconcludedthefirstfullyearofthenewDonateLifelicenseplateinMichigan. We set a goal of 2,000 plates sold by the end of August, and we hit it! If you don’t have a plate yet, please purchase one at Michigan.gov/SOS.

In the end, of course, our mission is all about the power to heal lives. In 2012, 261 organ donors saved the lives of nearly 800 people, while 860 tissue donors led to countless thousands of improved lives. We are on pace to meet or exceed those numbers this year. We are forever grateful to all of those donors and totheirfamilies.Werecognizeeachoneofthemasahero.

Sincerely,

Richard PietroskiGift of Life Michigan CEO

AsIconcludemyfirstfullyearasexecutivedirectoroftheGiftofLifeFoundation,allIcansayis,“Whew!Whatayearithasbeen.”Itisanhonortobepartofsuchagreatorganizationandtoseethe creativity, the inspiration and, especially, the humanity that goes into the many programs the Foundation touches.

In this report, you’ll get a glimpse of the breadth of the Gift of Life Foundation’s work. But first, I’d like to thank ourBoard of Trustees for devoting its time and energy to ensure the Foundation provides good stewardship of its resources and provides the direction that is truly needed. This spring, the board adopted a new mission (The Foundation is dedicated to promoting and supporting Michigan’s donation and transplant community) and a set of guiding principles that can be found on the following page. While not dramatically different from the past, the mission and principles provide a clearer blueprint for the Foundation’s decisions.

Some things, of course, remain constant. The Gift of Life Foundation continues to provide direct support to patients who have received a transplant and to the transplant workers who care for those patients. Likewise, the Foundation continues to champion educational opportunities, including lending support to the Gift of Life Keystone Symposium, which brought health care staff from across the state – and indeed, the nation – to Novi this past May.

This report also will highlight our public education efforts, everything from funding for Team Michigan in the TransplantGamesofAmericatotheWolverinesforLifetoanewventure,“TheSoundsofSavingLives”gospelconcert this fall in Detroit. By helping to fund these projects, we know we are helping create a society where donation will one day be the cultural norm.

Yes, ithasbeenquiteayear.Butasweallknow, livesareatstake.Together,wecanallmakeapositivedifference.

Sincerely,

AnneKowalcyzkGift of Life Foundation Executive Director

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President Marianne Langlois, MSA Henry Ford Hospital

President Elect Becky Harris-Burns, RN, BSN, MBA Beaumont Health System

Immediate Past President Mohamed El-Ghoroury, MD St. John Hospital & Medical Center

Secretary Connie Mattice, RN, MS, CCRN Spectrum Butterworth Hospital

Treasurer Pamela Jones-Sexton, MBA United Bank and Trust

OFFICERS TRUSTEES gift of life foundation

board of trustees

The Foundation is dedicated to promoting and supporting Michigan’s donation and transplant community.

We envision a day when organ and tissue donation is the cultural normforallcitizensinMichigansothatnoonedieswaiting.

As good stewards of public support, we manage our costs vigilantly, to increase resources that will support grants to the community and transplant centers.

Weprovidegrantsoffinancialassistancetotransplantcenters,post-transplantrecipientsandwaitingcandidatestohelpwithfinancialchallenges and transplant successes.

We promote the cause of organ and tissue donation and transplantation in the community by funding public and professional education efforts.

TheGiftofLifeFoundationisanon-profitmembershiporganizationcomposed of health care professionals and public representatives involved in organ and tissue donation and transplantation. It has been designated as a 501(c)(3) charitable and tax-exempt organizationbytheInternalRevenueServiceandisfurthertreatedby the IRS as a supporting foundation to Gift of Life Michigan.

The Gift of Life Foundation is managed by a Board of Trustees, eachelectedtoasix-yearterm.Inaddition,officers(president,president-elect, past president, secretary, and treasurer) are elected to two-year terms, and past presidents also serve on the board.

By becoming a member of the Gift of Life Foundation, you will support the grants and activities that increase professional growth and boost donor registrations and transplant awareness among the public.Pleasetakeamomenttofilloutthemembershipformattheback of this report to make a difference in the Michigan donation and transplant community.

Mission

GuidingPrinciples

What the Foundation is

Membership

Patricia Jo Herndon Michigan Donor Family Council

Timothy Keener, MBA Keener and Associates

Lisa Langley, RN Michigan Eye-Bank

Nancy Satmary, BSN, MHA St. John Hospital & Medical Center

Andrea Spraggins, LMSW Harper University Hospital

Marie Trojanowski, Retired RN St. John Hospital & Medical Center

Therese Winslow, RN, BSN Retired, Mercy Health Saint Mary’s

Michael James, DO, FACC Thoracic and Cardiovascular Institute Not pictured.

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Hurley Wall Team Michigan FansSounds of Saving Lives Concert

statement of activities Changes in Unrestricted Net Assets Unrestricted revenue: Interest & Dividends 52,043 48,270 Membership dues 2565 2870 Contributions 175,298 72,732 Total unrestricted revenue 229,906 123,872

Expenses: Management and general Accounting 1,600 1,600 Office&Printing 1845 1046 Administrative Support 22,000 22,625 Meeting 7,732 12,512 Program Grants 134,524 102,019 Recipient Grants 40,819 40,559 Social Work Transplant Fund 12,000 12,000 Total Expenses 220,520 192,361

Gain/(Loss) on Investments: 55,949 30,986Increase in Unrestricted Net Assests 65,334 (37,502)Changes in Temporarily Restricted Net Assests Contributions 0 0 Net assests released from restrictions 0 0Increase (Decrease in Temporarily Restricted Net Assests 0 0Increase in Net Assests 65,334 (37,502)Net Assests - Beginning of year 1,830,393 1,867,895Net Assests - End of year 1,895,727 1,830,393*through 6/30/2013

gift of life foundation

Every year, the Gift of Life Foundation distributes thousands of dollars to promote organ, tissue and eye donation, to honor donor families and to help transplant recipients cover their costs. On these and the following pages, you will see some of the programs that have been made possible by Foundation

grants this year and in the past.

gift of life foundation Programs

Grant Type 2009 2010 2011 2012 2013 TotalCommunity Grants 34,536 44,777 149,680 102,019 134,524 $465,536Williams Recipient Grants 43,764 37,773 44,273 40,559 40,819 $207,188Social Work Fund Grants 13,5000 13,500 13,500 12,000 12,000 $64,500

Sounds of Saving Lives ConcertThe Foundation contributed $5,000 for

promotion of this year’s Sounds of Saving Lives concert in Detroit.

Hurley Wall A Gift of Life Foundation grant allowed Hurley

Medical Center in Flint to unveil a memorial wall for donors earlier this year. A new Foundation grant will let Hurley expand the wall digitally

with a monitor that honors new donors.

Team Michigan Fans Foundation funding helped Team Michigan

buy uniforms for the Transplant Games of America last year in Grand Rapids and will support the

team again in 2014 in Houston, Texas.

2013* 2012 General Fund General Fund

balance sheetAssetsCurrent Assets CashandCashequivalents $96,106 $157,584 Investments 1,805,999 1,698,007 Total current assets 1,902,105 1,855,591

Property and Equipment-net 0 0 Total assets $1,902,105 $1,855,591

Liabilities and Net AssetsCurrent Liabilities-Accounts payable 6,377 25,198

Net Assets Unrestricted: Designated by the Board 0 0 Other unrestricted 1,895,727 1,830,393 Total unrestricted 1,895,727 1,830,393

Temporarily restricted 0 0 Total net assets 1,895,727 1,830,393 Total liabilities and net assets $1,902,105 $1,855,591

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Peace of Mind Registry - $95,000 Team Michigan - $13,000

The bill creating the advance directive registry was signed into law in June2012,anda$95,000FoundationgranthashelpedGiftofLifeMichigan set up the program during the past year. The Registry will launch soon at mipeaceofmind.org.

Gift of Life is under contract with the Michigan Department of Community Health to create and maintain the Peace of Mind Registry. It will operate the Registry at no expense to the state or taxpayers.

The Registry allows citizens to upload their advance directives intoa secure website, which they or their healthcare providers could access as needed. Advance directives are legal documents allowing individuals to specify patient advocates, religious preferences and other decisions about end-of-life care ahead of time.

“GiftofLifeisanaturalfittoserveastherepositoryofthisRegistry,”saidRichardPietroski,theorganization’sCEO.“Wealreadyoperatea24/7 communications center and have a dedicated line accessible to hospitals. Just as we are charged with the sacred trust of maintaining citizens’ ‘advance directive’ to be heroes to others through theMichigan Organ Donor Registry, we will provide the same for the PeaceofMindRegistry.”

Pietroskiadded:“WearegratefultotheGiftofLifeFoundationforitssupportinmakingthisserviceavailabletoMichiganresidents.”

Governor Rick Snyder is joined by state Sen. Jim Marleau, Gift of Life’s Richard Pietroski and other healthcare advocates as he signs the bill creating the new Peace of Mind Registry.

The Gift of Life Foundation is a major contributor in helping

to create the new Peace of Mind Registry, whichgivescitizenstheopportunitytofiletheir

advance directives in a secure database that

can be accessed by healthcare providers,

when needed.

(over two years)

Howdoyoudefinesuccess?Onewaywouldbetocountmedals,asin69gold,39silverand27bronzeforTeamMichiganatthe2012Transplant Games of America in Grand Rapids.

Anotherwouldbetorecognizethattheteammemberssentapositivemessage about organ, tissue and cornea donation, thanks in part to the support of the Gift of Life Foundation.

The Foundation provided Team Michigan with funding for uniforms, pins and other expenses both at the inaugural games in Grand Rapids and for the upcoming 2014 Transplant Games of America in Houston, Texas.

Team members include transplant recipients, living donors, donor family members and others interested in promoting donation.

“ThankyouagaintotheGiftofLifeFoundation for helping with Team Michigan’s success in 2012 and beyond,”saidthenteampresidentPaul Leonard.

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Wolverine for Life- $15,000 Gift of Life Symposium - $5,000

Medical Examiner Investigator Accelerated Death Reporting- $6,500

The group followed its successful Be a Hero at the Big House event in November 2012 with bone marrow screening and organ donor drives on the U-M medical campus. The efforts, which were supported by a Gift of Life Foundation grant, yielded 55 potential bone marrow donors, 17 new organ/tissue donors, and 36 blood donor appointments.

The Wolverines for Life student chapter at the Medical School held their own bone marrow drive and signed up 75 percent of their student body!

In June, Wolverines for Life won the Donate Life America Pinnacle AwardintheAffinityPartnershipscategory.Thegroupisnowplanningits 3rd annual Be a Hero at the Big House drive on two levels of the Jack Roth Stadium Club. The blood unit goal for this event will be the highest ever set for a campus drive.

Wolverines for Life – a coalition of donation

proponents led by the University of Michigan

Transplant Center – continues to raise the bar for its programs.

per year for four years

A Foundation grant helped make “TheEvolvingWorldofDonation&

Transplantation”ahugesuccess this year.

A Foundation grant should help ensure that the reporting is as fast as possible. The grant will pay for IPads with 3G connectivity for the investigators, so they will be able to enter information into MDILog (a Web-based database) in real time at the scene.

The program will be initiated in Kalamazoo,Muskegon and Allegan counties. The reporting rates will then be compared with past rates in comparable sized counties to see how the program can bereplicated or improved elsewhere.

When medical examiners promptly report deaths occurring outside of hospitals to Gift of Life Michigan,

tissue recovery rates increase significantly.

The Gift of Life Symposium, done in collaboration with the Michigan Health & Hospital Association, brought together nearly 450 physicians, nurses and healthcare professionals from across the state for the one-day event in Novi.

Participants heard about latest trends and cutting-edge advances in donation and transplantation, along with inspiring stories of how and why their work is so important to so many people in Michigan.

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Williams Memorial Grant Fund & Transplant Social Worker’s Patience Assistance Grants

“The financial grant for medical expenses has enabledme to buy a MediGap insurance policy, which has been a life saver. It truly has made a difference in reducing stress over medical bills and enables me to adequately plan forupcoming doctor visits and procedures and travel expenses.”

– anita sutkovs, liver recipient

“IwashumbledandappreciativetonoendwhenIreceivednewsofmyfirstgrant.Iactuallycametotearssittingaloneinmykitchenreadingthenews(aboutthefinancialhelp).WhenIgetthatletterfromG.O.L.F.,a feeling of thankfulness and relief overwhelms me every time. Words can’t express what all recipients of this wonderful gift must feel.”

– Dennis Ganske, double-lung recipient

“As the lung transplant social worker at the University ofMichigan, I have seen financial resources and assistance foradult transplant patients dwindle while the needs have grown. Being able to easily access the Gift of Life Foundation Williams Grants for my patients has been without a doubt priceless.”

– Lisbeth Harcourt, university of Michigan Lung transplant program

Sounds of Saving Lives Gospel Concert - $5,000

This year, the Gift of Life Foundation has thrown its support behind the Sounds of Saving Lives Concert, an annual gospel concert organized by theGift ofLife Minority Organ Tissue Transplantation Education Program (MOTTEP).

The Detroit concert celebrates National Donor Sabbath Weekend by adding music to the message of saving lives through organ, tissue and eye donation. The Foundation grant enabled Gift of Life MOTTEP to bring in the Detroit chapter of the Gospel Music Workshop of America.

The concert also honors those who have promoted donation in their faith community.

Since its first “Bringing Organ Donation Awareness to our FaithCommunities” seminar in 2005, the Donate Life Coalition ofMichigan has had 400 participants with a potential outreach of well over 130,000 people.

As with previous sessions, this year’s seminar, at Temple Israel in West Bloomfield, provided attendees with a view of palliative care/end-of-life issues, a spiritual perspective of organ and tissue donation, personal recipient and donor family stories, an explanation of the donation process and a discussion on religious views on organ donation.

The participants leave with materials they can use immediately to bring donor awareness to their faith communities. In addition, continuing education units are awarded to nurses, social workers and chaplains.

The Coalition’s CathyWarren added: “We areso grateful to the Gift of Life Foundation for this grant that has allowed us to bring the message of organ, tissue and eye donation to those who can, inturn,bringittothousands.”

Every year, the Gift of Life Foundation provides

direct assistance to transplant recipients

through the Williams Memorial Grant Fund,

along with money to social workers to use for their patients. Here are

excerpts of what some of the recipients had to say:

A little TLC: The Foundation also offers support to other programs that work directly with patients, such as the Transplant Living Community program of the

Henry Ford Transplant Institute.

Faith Ministry Seminar - $5,000per year for four years

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Be an Organ, Eye & Tissue Donor

Cost: $35extrafortheoriginalplate,and $10forsubsequentrenewals

Benefits: Thedonationpromotionfundreceives $25oninitialordersand$10thereafter

To order: Download a form at Michigan.gov/SOS and clickon“OwningaVehicle.”OrvisitanySOSoffice.Youdon’thavetowaitforyourcurrent plate to expire, and you’ll receive your new plate in the mail within 14 days.

To join the Michigan Organ Donor Registry, go to www.giftoflifemichigan.org

show your support!

gift of life foundation

Michigan’s new Donate Life license plate encourages residents to give the gifts of life, sight and mobility and provides funding to promote donation.

The Gift of Life Foundation is funded by your annual membership fee. Please take this opportunity to support an organization that is dedicated to community outreach

specifically centered on organ, tissue and eye donation and transplantation.

gift of life foundationThe Foundation thanks these top contributors and the many others whose gifts

allow it to carry on its mission in support of Gift of Life Michigan.

Abbott Labs Employee Giving Campaign Accident Fund Holdings Inc. Nancy and Steve AlberyJudith AlbrechtCarol AllenAmeriprise Annual Giving Campaign Jenny AmosCarl and Patricia AndersonDaniel and Abby AndersonTom ArnoldCharlie and Lois ArnsonAssociated Retinal Consultants, P.C. George and Linda AttardM. Judith AugustineBeverly BallorDewitt BarrelsAngela BaxterLeslie BeanEverett BellMary Ellen Shea Bell Alfred Bembeneck and family Jennifer BergenJerome and Nancy BerkeschDon and Linda BernardiBetsie Bay Medical Center Bonnie BeutlerDiana BeveridgeBabette BiernatKelly BilaShirlene BilaRuth BlackleyAngela BlakeRichard E. BlueRuth BluntKathi BokanoRonald BordenKirsten BorgstromElaine and Charles BoyceGarry and Valerie BoyerPatricia BoyerDonna and Jack BrandiGabriele BresettBriana BrownJudith Burns Larry and Janelle Busdeker Sam and Evelyn CalcharyNancy CallCards For Causes Ben CaudillMichael CaudillJessica CelascoAndrew and Carol Cerny Daniel and Lisa CetnarGene ChamberlainJan ChapmanMary ChapotonCheryl Chaves-TorresChemung Hills Golf & Banquet Center Sarah ChristiansonHeather ChunkoMaureen CicolaKaren Clark and family CliftonLarsonAllen LLP Charlie and Sue ColeJim ColeRichard ColeLori Coluzzi Jessica Cooper

Cathleen Corona-MelodyCo-workers of Cheryl Crawford John CrawfordCurtis Wolverton Ladies Auxiliary Post #3243 Gary CutlerTim and Terissa Daly Ramsay DassDataxstream Inc. Colleen DaymonEdward DeanJohn and Judy DeckertDelta Dental Ann DemaraAnn DickasonJames and Karen Diehm Deborah DixonDLT Solutions Barry Dosser and familyDanny DotsonElizabeth DrakeJulie and Paul DratzKristy DunniganRandy DusseauMarlene DykstraEdward White, Inc. Sharon EiseleTimothy EiseleEmbers Bar and Grill Barb Essenberg and familyExel DHL Inc. Farbman Group First Community Federal Credit Union Nkie ForsacFrankfort Building Supply Annette FreidFriends in Classics Book Club Tom FullerJannine GarrettAlexandra GastarisGates Foundation Jeffrey GehresJanet GibbsChristine GierlowskiFlorence GilcherCarol GilletteMarianne GladstoneGolfer S.O.D.A. and Lonnie Atherton Gowanie Golf Club Richard GrahamGregory GriewahnSteve and Elaine GrolleGlenda HallJudy A. Hall Valerie G. Hammond Handler Funeral Homes Inc. Kristen Harkonen and the Horner family Dave and Jane HarlowKelly and Daniel HarrisMichelle and Austin HarrisNorma HartRebecca HartNancy HecoxMatthew HennesseyDeanna HerbolsheimerTheresa HerbstErika HernandezNichole Hickcox

Joanna HicksKim HilitzMichele HillShirley Hoffman Rita HollisKelly HorschStephen HoszkinEdward HoweBarbara HranilovichDavid HuberLeo Hughes HughesJudith HurstI3 Logic Company Intrinsic Medical Imaging Christine JanickiL.K. JedrzejasConstance A. Jedrzejas Trust Darwin and Kay JohnsonSteve JohnsonKalamazoo Christian School Association Dorothy KangasMachell KathanKristine Marvin KeenerJosh KellstromJohn and Ann Kendrick Mr and Mrs William Kennings Jessica KingJ. Paul and Dawn King Kirsen KleinJohn and Deb KoetsierFranklin KorsonAmy Korver-MurarKen and Denise KruppDr. Manish Kumar-VarmaJoanna KurnytaLapeer West Football Club Marjorie LeidleinHarry LeslieLinda Levandowsky Mark LezotteMichael and Janet LieckfeltLifestyle Tracs, Inc. Lion’s Club of St. Joseph Gayle and Diana LohrbachJill LopesRandy and Deb Lowell Marlys LoyerLucky Farmers, Inc. Sarah LuggerPhillip and Beth Lugger Jeannine M. SmithM.S.U. Food Nutrition Association Macomb County District CourtJennifer MadaraszMagna Exteriors and Interiors Judy A. MainMaltby Middle School James MarkJenny and John MartinsMartins Home Center Kristine Marvin Carolyn MaryniakJanet and David MasseyPegi MathenyM. Andrea MatteiJanet McClellanJohn and Sharon McGehee McLaren Macomb Lab Dept.

Robert and Marie McMurrayKurt MenapaceNick and Greta MerandiMercedes Benz Tech Center Elaine Ann MierzejewskiGlen J. MiliganDanielle MillerCarol MitriRon and Sue MoenterCheryl MonroeMatthew MooreDebra and Elizabeth MorisonMott Foundation John MoulderChris and Bridget MouwGarret and Susan MouwEileen Murphy and Friends Rosemary MurrayJohn and Chris MusichMy Tribute Gift Foundation Carol Ann MyersMyjewelthief.com Raymond and Judith O’Beryer Susan O’BrienRobert and Marie O’BrockKevin O’ConnorJennifer OhThomas OlbrychSally O’NeallDaniel and Marci Kay OrrellGary and Barbara OstranderJigar PatelPathfinder Manufacturing David PatrickusKarl and Susan Paul David PerreaultPheney Inc. Construction Service Michael and Lisa Phillips Roger and Bethany Phillips Philip and Melissa PiepsneyRosemarie PitschPlante and Moran Pleasant Landscaping Claire PoirierLynn and Chris Polaczyk Tom PollockSteve and Tammy PopchockPower Puff Golf Team Premier Freight Management Corporation Shirley and Bruce PrivackyPaul PucherNicholas and Karen PyettAnthony and Amanda QuagliatoRolando and Sue Quiroga Raisin Valley Golf Club Inc. Sam and Anne Marie Randazzo John and Judith Rasbach Renato and Julie Razon Chuck and Kathy ReddickForrest and Nancy ReedBruce ReinkeJoseph and Sharon RheinBill and Diane RhodesRichard Brown Contracting, Inc. Steve and Carolyn RichardsGail RinkeElizabeth RubensteinRygate Corporation

Michael SarbNancy SatovskyDavid and Melissa SauterWilliam Sawyer Jr. Barbara SaxenaBetty SchenckEileen SchneiderKathleen ScottJane and John SeatterJudith Sellers Shah and Georgia Shahbazi Mary Ellen Shea Kelly Shea-Miller Cathy and James ShijkaGabriel SisolerJoan C. SmithSid Smith Judith Smith and familyKathyrn SnyderVelette SnyderRachel SobczynskiLiz SopoligaMaria and Nicholas Souris Lawrence SpiterSPX Foundation State Savings Bank Joan SternScott and Jennifer StierBob and Gail Stinson-GeerlingMichelle StratzKaren StrugholdIvy SueAmanda Sulesky-Fishman Joan and Gret SutherlandMary SutherlandEmily Swan-Hansman Janet and David SwartzStephanie SwartzPeter TenutaTerumo Community Foundation Sydney ThompsonMichael TinoRichard TrombleyMark TrottnowDavid and Cindy ValkanoffNancy VallenderCarron and Dave VasilkoRuth WaalkesWallace & Comstock PLLC Mel WaltersJackie WanagatLisa WelchWhite Bolles Elementary School John Whitmer Whitmore Elementary School Mr and Mrs Richard Whitney Stephanie and Corey WieckowskiMr and Mrs Donald Wierschke Gretchen and Bob WilbertJulie WilleyLinda Wilson William WoehlerWright & Filippis Michele ZacksJoe Zielinski

Please Print

Name ___________________________________________________________

Title/Affiliation _____________________________________________________

Address __________________________________________________________

City, State, ZIP _______________________________ ________ __________

Phone ___________________________________________________________

Email ____________________________________________________________

To pay your membership or make a monetary donation by credit card:

Credit card number: ______________________________________________

Expiration date: _______________ Security code: ______________________

Billing Zip Code: _________________________________________________

Or call: (800) 482-4881, ext. 1046

A Donate Life Organization

Membership Fee: $35.00 per yearMembership is from 7/1/13 to 6/30/14

Mail this form and membership fee to:Gift of Life Foundation

Attn: Finance Department3861 Research Park Drive

Ann Arbor, MI 48108

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gift of life foundation Key Dates

January 2, 2014 Applications for Gift of Life Foundation Community grants and

Lecture Series grants for the 2014 fiscal year (beginning July 1, 2014) will become available on the Foundation’s web page at:

giftoflifemichigan.org/about-us/ and then click on “Gift of Life Foundation” in the left column

March 3, 2014

Community grant and Lecture Series grant applications are due

May 7, 2014

The Gift of Life Foundation Board of Trustees meeting

November 20, 2014

The Gift of Life Foundation annual membership meeting

Join the Michigan Organ Donor Registry at:www.giftoflifemichigan.org

The Gift of Life Foundation3861 Research Park Drive, Ann Arbor, MI 48108

(800) 482-4881 | www.giftoflifemichigan.org