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Please fill out this form and send it in with your donation either via snail mail or via fax. Simply cut and paste for your convenience.The Mautner Project THANKS YOU for your support of lesbian health.
Mautner Project Donation Form
Name(s): _______________________________________________________________________
Address: _______________________________________________________________________
Email: _________________________________________________________________________
Day Phone: _____________________________ Eve Phone: _________________________
I/we would like to sponsor Here is a gift of: ___________________________________________
Other: $_______
A check payable for $________ to the Mautner Project is enclosed, or:
Please charge my credit card: VISA MC DISC AMEX
CC #: _________________________________________ Exp. Date: _________________
Signature: ______________________________________________
The Mautner Project
1707 L St NW, Suite 230
Washington, DC 20036
(202) 332-5536
www.mautnerproject.org
Fax (202) 332-0662
The Mautner Project is a 501(c)(3) organization (ID # 52-1703915).
For more information about the Mautner Project,
please contact us at (202) 332-5536 or mautner@mautnerproject.org.
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