Friends of BrainHealth

Join the Friends of BrainHealth at the UT Dallas Center for BrainHealth. If you are not able to commit to a Friends of BrainHealth membership at this time, but would like to give a gift, please visit the Center for BrainHealth's secure online donation form.

Please check no below in the "Waive my benefits" box if you'd like to waive the benefits associated with this membership so that 100% of your gift is tax deductible.

**If you would like to give the gift of a Friends of BrainHealth membership, please include the name of the recipient below. Gail Cepak will contact you for additional information.

Make a Gift

Use this form to securely make your online donation. Fields marked with an * are required.
UT Dallas Faculty and Staff, use the payroll deduction form to make a payroll deduction.

Membership Levels

Amount:

Associate

$ 250.00

Companion

$ 500.00

Friend

$ 1,000.00

Special Friend

$ 2,500.00

Esteemed Friend

$ 5,000.00

Distinguished Friend

$ 10,000.00

Visionary Friend

$ 25,000.00

Additional Information

Type of gift:

One-time gift
Recurring gift
Installments

Corporate:

This donation is on behalf of a company

Anonymous:

I prefer to make this donation anonymously

Comments:

Waive My Benefits:

**This membership is a gift for:

Mailing Address, if different from Billing Address:

Planned Giving:

Send info about donor advised funds, stocks, wills, etc.

Billing Information

Title:

First name:

*

Last name:

*

Country:

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Address lines:

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City:

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State:

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ZIP:

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Phone:

Email:

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Payment Information

Cardholder's Name:

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Credit Card Number:

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Card Type:

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Card Expiration:

/

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Card Security Code:

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Matching Gifts

My company will match my gift

Tribute Information

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Name:

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Mail a letter on my behalf

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UTDallas

Friends of BrainHealth

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