The Northern Nevada Branch of Juvenile Diabetes Research Foundation is proud to honor Dr. David and Maryann Zucker with the 2009 Vision Award at our Tribute Gala on May 9th.
We need your help ~ Pay tribute to Dr. Zucker or tell us your favorite Dr. Zucker story!
Name of Dr. Zucker’s Patient: _____________________________________________________________________ Male Female Date of Birth: ___________ Mailing Address: _______________________________________________________________________________ City: ____________________________________ State: ______________ Zip: _____________________ Phone: ______________________________________ Email: _______________________________________
Tell us your favorite Dr. Zucker story/memory or just write a brief tribute for him about what he’s meant to you and your family. It will be part of a special gift for Dr. Zucker. Deadline is Friday, April 24, 2009.
If possible, it would be much appreciated if you can email a photo of yourself or child when you were first a patient of Dr. Zucker’s and a photo of yourself or child now. Please fill out this form and mail it to: JDRF, 5335 Kietzke Lane #230, Reno NV 89511, fax to 775.827.0131 or e‐mail to northernnevada@jdrf.org . You can also stop by our office and we can scan your photos for you.
For details on purchasing tables or tickets to the JDRF Gala event, or if you have any questions at all, please contact the office at 775.786.1881 or through e‐mail northernnevada@jdrf.org. Yes, I want to make a donation to the JDRF research grant in Dr. David & Maryann Zucker’s name!
(JDRF will let them know that you contributed to this research grant.)
PAYMENT INFORMATION My check for $___________ is enclosed. (Payable to Juvenile Diabetes Research Foundation, tax‐exempt #23‐1907729)
Please bill my credit card: ___Visa ___MC ___DISCOVER___AM EX # Exp. Date: _____________
Signature: _____________________________________________________________________
Please invoice me in full at the above address.