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:

Terry Pell
President
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:

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):

 

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