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 Contribution Form
Street Address: __________________________________________________________________
City, State, Zip: __________________________________________________________________
Telephone: _____________________________ Fax: _________________________________
I would like to make a one-time donation in the amount of $: ___________________
I would to become a monthly donor in the amount of $ $: _______________________
I would like my recognition listed as:
My total payment amount: $ __________________________________________________________
Method of Payment
Please provide full payment with the completed form and return by fax or mail to the address below.
Payment by Credit Card: Payment by Check:
American Express Make checks payable to Mautner Project
Card Number: ________________________________ Expiration Date: _________________
Card Holder's Signature: __________________________________________________________
Mautner Project: The National Lesbian Health Organization
1300 19th Street, NW, Suite 700, Washington, DC 20036
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 firstname.lastname@example.org.