Please print out this page and send your tax-deductible contribution payable to:

World-India Diabetes Foundation (USA)
K. Sreekumaran Nair, M.D., Ph.D., Chairman WIDF
Robert A. Rizza, M.D., Treasurer WIDF
200 First Street SW, 5-194 Joseph
Rochester, MN 55905
USA

Contact information: widfusa@yahoo.com

Phone: (507) 255-2415 / Fax: (507) 255-4828

Name: ____________________________________________
Street Address: _____________________________________
City: _____________________________________________
State: ___________________      Zip: ___________________
Country: __________________________________________

*World-India Diabetes Foundation reserves the right to decide best use of funds