Fifty/Fifty Leadership PLEASE PRINT THIS FORM I want to receive The Equality Standard in my e-mail box every month. Sign me up! One year subscription to The Equality Standard is $15 Name: ____________________________________________________________________ Address: ___________________________________________________________________ Phone: Day ( )________________________________ Eve ( ) _________________________ Email: _____________________________@_____________________________________ Make check payable to: Fifty/Fifty Leadership ___ I wish to charge my subscription to: (Circle one)
Credit Card No. ______________________________________ 3 or 4 Digit Code _________ Expiration Date: Mo.______ Year ______ Amount: $_____________ Name as it appears on the credit card: ___________________________________________ Signature:_________________________________________________________________ Please mail your subscription request with this form to: P.O. Box 11202 Phone: (818) 243-2322 Fifty/Fifty Leadership was incorporated in Las Vegas, Nevada in 1996. |