Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Which fund(s) would you like to support? (tax-deductible)

Annual Fund
Fund for Choice

Would you like to contribute to the Action Fund? (not tax-deductible)

Yes No

Would you like us to contact you to discuss a bequest or a gift of stocks?

Yes No

Would you like to make a tribute or memorial gift?

Yes No

Please choose the appropriate button:

In Honor of
In Memory of

If this is a tribute gift, who would you like to honor? What is the occasion?

How much would you like to contribute?

Please provide the following payment information:

	Please charge my:
Credit Card	VISA MasterCard
Cardholder Name
Card Number
Expiration Date

Any additional questions or comments?