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Contribution Form |
| Date __________ | Member ____ Non-member ____ |
Name _______________________________________________ Chapter # (if applicable) _______
Address _________________________________________________________________________
City/State/Zip _____________________________________________________________________
Phone (_____ )__________________________ E-mail address _____________________________
I heard about Mothers & More from ___________________________________________________
Contribution amount (in U.S. funds)Yes, I want to invest in Mothers & More’s future and a brighter future in general for sequencing mothers! Here’s my tax-deductible donation of
_____ $25 Friend
_____ $30 Family
_____ $50 Advocate
_____ $100 Mentor
_____ $250 Visionary
_____ $500 Millennium Club
_____ Other amount (please specify) $________
Method of payment
____ MasterCard ____ Visa Name on card ____________________________ Card number _____________________________ Exp. date (m/y) ___________________________ Signature ________________________________ |
____ Check, payable to Mothers & More |
We appreciate your support!
Mail to: Mothers & More, P.O. Box 31, Elmhurst, IL 60126-0031. Credit card donations only may fax to: (630) 941-3551. Your donation to Mothers & More, a 501(c)(3) not-for-profit organization, is tax deductible. Questions? Contact the Mothers & More National Office at (630) 941-3553, or at nationaloffice@mothersandmore.org.