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Dzau Transformation Fund) /E (Victor J. Dzau Transformation Fund) /Pg 7 0 R /K [3] >> endobj 24 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [36] >> endobj 25 0 obj << /Type /StructElem /S /H4 /T (Committee on Human Rights \(CHR\)) /E (Committee on Human Rights \(CHR\)) /Pg 7 0 R /K [2] >> endobj 26 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [37] >> endobj 27 0 obj << /Type /StructElem /S /H4 /T (Victor J. Dzau Emerging Leaders in Health and Medicine) /E (Victor J. Dzau Emerging Leaders in Health and Medicine) /Pg 7 0 R /K [5] >> endobj 28 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [38] >> endobj 29 0 obj << /Type /StructElem /S /H4 /T (Other:) /E (Other:) /Pg 7 0 R /K [4] >> endobj 30 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [39] >> endobj 31 0 obj << /Type /StructElem /S /H3 /T (Donation amount:) /E (Donation amount:) /Pg 7 0 R /K [14] >> endobj 32 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [40] >> endobj 33 0 obj << /Type /StructElem /S /P /E (If you would like to establish a recurring donation, please use our online donation form at www.nam.edu/donate.) /Pg 7 0 R /K [6] >> endobj 34 0 obj << /Type /StructElem /S /H3 /T (Donor name\(s\):) /E (Donor name\(s\):) /Pg 7 0 R /K [10] >> endobj 35 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [41] >> endobj 36 0 obj << /Type /StructElem /S /H3 /T (Donation details \(if applicable\):) /E (Donation details \(if applicable\):) /Pg 7 0 R /K [7] >> endobj 37 0 obj << /Type /StructElem /S /H4 /T (My gift is in memory of:) /E (My gift is in memory of:) /Pg 7 0 R /K [11] >> endobj 38 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [42] >> endobj 39 0 obj << /Type /StructElem /S /H4 /T (My gift is in honor of:) /E (My gift is in honor of:) /Pg 7 0 R /K [12] >> endobj 40 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [43] >> endobj 41 0 obj << /Type /StructElem /S /H4 /T (My gift will be matched by:) /E (My gift will be matched by:) /Pg 7 0 R /K [13] >> endobj 42 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [44] >> endobj 43 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [45] >> endobj 44 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [46] >> endobj 45 0 obj << /Type /StructElem /S /P /E (I would like to learn more about planned giving opportunities.) /Pg 7 0 R /K [9] >> endobj 46 0 obj << /Type /StructElem /S /P /E (I have already included a gift to the National Academy of Medicine in my estate plans.) /Pg 7 0 R /K [8] >> endobj 47 0 obj << /Type /StructElem /S /H2 /T (Billing Information) /E (Billing Information) /Pg 7 0 R >> endobj 48 0 obj << /Type /StructElem /S /H4 /T (Name:) /E (Name:) /Pg 7 0 R /K [23] >> endobj 49 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [47] >> endobj 50 0 obj << /Type /StructElem /S /H4 /T (Address:) /E (Address:) /Pg 7 0 R /K [24] >> endobj 51 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [48] >> endobj 52 0 obj << /Type /StructElem /S /H4 /T (City:) /E (City:) /Pg 7 0 R /K [25] >> endobj 53 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [49] >> endobj 54 0 obj << /Type /StructElem /S /H4 /T (State:) /E (State:) /Pg 7 0 R /K [26] >> endobj 55 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [50] >> endobj 56 0 obj << /Type /StructElem /S /H4 /T (Zip:) /E (Zip:) /Pg 7 0 R /K [27] >> endobj 57 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [51] >> endobj 58 0 obj << /Type /StructElem /S /H4 /T (Phone:) /E (Phone:) /Pg 7 0 R /K [28] >> endobj 59 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [52] >> endobj 60 0 obj << /Type /StructElem /S /H4 /T (E-mail:) /E (E-mail:) /Pg 7 0 R /K [29] >> endobj 61 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [53] >> endobj 62 0 obj << /Type /StructElem /S /H2 /T (Payment Information) /E (Payment Information) /Pg 7 0 R >> endobj 63 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [54] >> endobj 64 0 obj << /Type /StructElem /S /H4 /T (Check made payable to the National Academy of Medicine is included.) /E (Check made payable to the National Academy of Medicine is included.) /Pg 7 0 R /K [15] >> endobj 65 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [55] >> endobj 66 0 obj << /Type /StructElem /S /H4 /T (Charge my credit card:) /E (Charge my credit card:) /Pg 7 0 R /K [16] >> endobj 67 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [56] >> endobj 68 0 obj << /Type /StructElem /S /H4 /T (Visa) /E (Visa) /Pg 7 0 R /K [17] >> endobj 69 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [57] >> endobj 70 0 obj << /Type /StructElem /S /H4 /T (MasterCard) /E (MasterCard) /Pg 7 0 R /K [18] >> endobj 71 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [58] >> endobj 72 0 obj << /Type /StructElem /S /H4 /T (American Express) /E (American Express) /Pg 7 0 R /K [19] >> endobj 73 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [59] >> endobj 74 0 obj << /Type /StructElem /S /H4 /T (Discover) /E (Discover) /Pg 7 0 R /K [20] >> endobj 75 0 obj << /Type /StructElem /S /H4 /T (Card Number:) /E (Card Number:) /Pg 7 0 R /K [21] >> endobj 76 0 obj << /Type /StructElem /S /Figure /P 15 0 R /Pg 7 0 R /K [60] >> endobj 77 0 obj << /Type /StructElem /S /H4 /T (Exp. 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