Mail your completed form and check or
money order to:
Eyedrum
Suite 8
290 MLK Dr., SE
Atlanta, GA 30312
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|
info@eyedrum.org • www.eyedrum.org • 404-522-0655
|
|
Member Information:
___New ___Renewal ___ Gift
|
| Individual Memberships |
Friend $35
Partner $50
Pal $75 |
Buddy $100
Comrade $500 |
| Member Information: |
| Your Name |
_____________________ |
|
Address
|
_____________________ |
| City |
_____________________ |
| State |
_____________________ |
| Zip |
_____________________ |
| Country |
_____________________ |
| Phone |
_____________________ |
| Email |
_____________________ |
| If Gift, From... |
| Name |
_____________________ |
| Address |
_____________________ |
| City |
_____________________ |
| State |
_____________________ |
| Zip |
_____________________ |
| Country |
_____________________ |
| __Please let me know how I can help as
a volunteer. |
__My employer has a matching
gifts program.
__ I have enclosed the completed matching gift form.
__ Please contact my employer, ______________at phone #, _________
for the forms.
|
| Please send this completed form with
a check or money order to: |
Eyedrum
Suite 8
290 MLK Dr., SE
Atlanta, GA 30312 |
| |
| Thank You!
|