|
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 is a 501(c)(3) organization (ID # 52-1703915). ©Mautner Project | 1875 Connecticut Ave. N.W. #710, Washington, DC 2009 | 202.332.5536 |