Fifty/Fifty Leadership
Donation Form Please print this form and mail to:
Name: _______________________________________________________________ Address: _____________________________________________________________ City/State/Zip___________________________________________________________ Phone: Day ( )_______________________ Eve ( ) _____________________________ Email: _______________________@_______________________________________ Make check payable to: Fifty/Fifty Leadership ___ I wish to charge my tax-deductible contribution to: MasterCard Visa American Express Discover (Circle One) Credit Card No. _________________________________ 3 or 4 Digit Code _________ Expiration Date: Mo.______ Year ______ Amount: $_____________ Signature:___________________________________________ Your contribution is tax-deductible in accordance with the law. Thank you for your strong support! Fifty/Fifty Leadership was incorporated in Las Vegas, Nevada in 1996. The phone number is (818) 243-2322. We have a 501(c)3 classification from the Internal Revenue Service. © 2009. This is a publication of Fifty/Fifty Leadership. All rights reserved. |