Mail-In Donation Form

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Thank you for your generous donation to The Micheli Center for Sports Injury Prevention. There
are two different funds you may choose to donate to, the Scholarship Fund and the Operating Fund.
We have established The Micheli Center Scholarship Fund to offer sports injury prevention
services to kids in financial need. The money donated to The Micheli Center Scholarship Fund will
be used any time a child comes in that cannot afford to otherwise pay for the services. The
Operating Fund helps cover the expenses of running The Micheli Center on a daily basis. We can
be reached at 857-218-4987 or by email at info@themichelicenter.com for more information.
Allocate my donation to the Scholarship Fund
Allocate my donation to the Operating Fund
Please provide us with your complete contact details:
First Name
Middle Initial
Address Line 1
Last Name
Suffix
Address Line 2/Apt Number
City
Country
Home Phone
State/Province
Zip/Postal Code
Work Phone
Email Address (required)
Donation Amount & Payment Method
I would like to make a tax-deductible donation to The Micheli Center for Sports Injury Prevention
in the amount of: $________________
Check
Please make checks payable to The Micheli Center and mail to:
Cristina Murphy
Division of Sports Medicine
319 Longwood Ave 6th Fl
Boston MA 02115
Visa
Mastercard
American Express
Cardholder’s Name
Cardholder’s Signature
Credit Card Number
Expiration Date
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You may also make a donation online at www.themichelicenter.com
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