Mail form: Financially assist CIR

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Send a contribution to CIR

Please complete the form below, print it, and mail it to us with your check, money order, or credit card information.

We are very grateful for your help.

Mailing address:

Megan B. Lott

Senior Director of Development
The Center for Individual Rights
1233 20th St., NW

Suite 300

Washington, DC 20036

First Name:

Last Name:

E-mail:

Phone:

Fax:

Address:

City:

State:

Zip Code:

I would like to donate:

$50 $100 $250 $1000

Other:

Earmark for CIR's Fund for Citizen Journalism

My tax-deductible contribution will be paid via:

Check
Money order
Credit card

Visa Mastercard
American Express Diners Club / Carte Blanche

Name on card:

Number:

Expiration date:

CVV number (last 3 digits on signature panel of Visa/MC):

CID number (4 digits above card number - AMEX only):

Last revised: 23-Jul-2013