Name____________________________________

Address__________________________________

City___________________State_____ Zip ______

We therefore pledge $_________ in support of this research.

Payment will be made over a period of ______ years,

beginning in _____________

with installments of $_______________.

Signed___________________________________

Date______________

AND/OR

Enclosed is my check for $_________________

Payable to the UMB Foundation - Center for Celiac Research.

My employer has a matching contribution program

Yes ____ No ______

Employer’s Name___________________________

Address__________________________________

I understand my pledge or contribution will be used to support this study at the center for Celiac Research at the University of Maryland School of Medicine and that my contribution is tax deductible. These funds are being managed by the UMB Foundation.

Please mail to:

The Center for Celiac Research
Pam King
Director of Operations
University of Maryland
20 Penn Street, Room S303B
Baltimore, MD 21201