You are on page 1of 1

Enclosed please find my donation (payable to APTi):

APTi Peace-on-Earth Donation Coupon


‰ $25 ‰ $50 ‰ $75 ‰ $100 ‰ Other: _____
I’m paying by:
________________________________________________
Name Check #: __________________________
Credit card: ‰ M/C ‰ Discover
________________________________________________
‰ Visa ‰ Am/Ex
Address
Card #: ________________________________
________________________________________________
Apt. or Suite # Exp. Date: ______________________________
Name
________________________________________________
City, State ZIP on card: _________________________________

Signature: _______________________________
________________________________________________
Phone(s)
Please send this coupon with your payment to: APTi, 9650
Rockville Pike, Bethesda, MD 20814-3998 USA – FAX – 301-
________________________________________________ 634-7455. Or call (toll free) 800-847-9943 to donate by phone.
Email(s)

You might also like