Individual Donor Form

!
!
Dear APAMSA alumni and friends,
On behalf of Asian Pacific American Medical Student Association (APAMSA), I welcome and
thank you for your interest in our organization. We are a 501(c)(3) nonprofit, nonpartisan
organization, and the only national organization with more than 90 chapters nationwide and
representing nearly 15,000 Asian and Pacific-Islander American (APIA) medical students.
APAMSA is committed to addressing the unique health challenges of the APIA communities
through education and service. We also serve as an advocate for the delivery of accessible,
quality healthcare for these communities, which represents over 10 million Asian and PacificIslander Americans. We are dedicated to improving cultural competency, promoting diversity in
health care, and building strong community relations.
Among our accomplishments, we have:
– Registered thousands of bone marrow donors
– Organized thousands of community health fairs
– Educated, screened, and immunized for Hepatitis B
– Provided numerous leadership opportunities for our members
– Hosted 19 national conferences and numerous regional conferences
– Served as a national forum for education, activism, and change
APAMSA is governed nationally by a Board of Directors, comprised of medical students elected
to the Executive Committee and to Regional Directorships. APAMSA also benefits from the
expert advice of its Physicians Advisory Board, which includes luminaries such as Dr. Samuel
Lin, former Assistant Surgeon General of the U.S., and Dr. Mohammad Akhter, former
Executive Director of the American Public Health Association.
This year we will be hosting our 20th National Conference at Columbia University Medical
Center from October 4-6, 2013. The theme, “Breaking the Silence in Asian Pacific Islander
American (APIA) Health” will bring together students and leaders from around the country to
learn about the unique challenges that APIAs face, which include, but are not limited to, issues
of health care access, language barriers, mental health challenges, and Hepatitis B.
Since APAMSA is a student-run non-profit organization, we rely on the generous donations from
organizations and corporations such as yours. Please join us in our efforts to further the
education and development of our future leaders. Enclosed you will find information on various
sponsorship options. On behalf of the Board of Directors, and the members of APAMSA, I look
forward to working with you and fostering a long-term relationship.
Sincerely,
Pratik Talati
APAMSA Chief Financial Officer
Vanderbilt University School of Medicine
[email protected]
!
APAMSA is a non-profit 501(c)(3) organization that does not deny
membership on the basis of race, color, sex, religion, national or ethnic
! origin, sexual orientation or physical disability.
!
!
National APAMSA Benefactor
Contact Name:
Position:
Address:
Telephone:
Fax:
Email:
Donation Amount: $
I would like my donation to go towards:
! APAMSA National Conference*
! APAMSA National Service Projects (Hepatitis B Outreach, Bone Marrow Initiative,
Community Health Fairs, etc.)
! Scholarships for APAMSA medical students in financial and academic need
! Where it is needed most
! Other:
*Donations may be used to purchase advertisements in our national program book at our 2013
National Conference. Pricing is as follows:
- $800: Full Page (8.5”x11”) Color
- $500: Full Page (8.5”x11”) Grayscale
- $300: 1/2 Page (8.5”x5.5”) Grayscale
- $200:1/4 Page (4.25”x5.5”) Grayscale
- $100: Business Card (3.5”x2”) Grayscale
Donations for the 2013 National Conference must be received by September 1, 2013.
Donations can also be made online at http://www.apamsa.org/support-us
Checks should be made payable to APA Medical Student Association, Inc.
Please submit this form with check to:
Pratik Talati
3120B Long Blvd Unit 203
Nashville, TN 37203
[email protected]
!
APAMSA is a non-profit 501(c)(3) organization that does not deny
membership on the basis of race, color, sex, religion, national or ethnic
! origin, sexual orientation or physical disability.
!