Note: This is the same list for which
you can sign up on the home page.
To contribute to Lone
Star FIJA, print this page, and fill out the form below and mail to:
Lone Star FIJA
P.O. Box 2682
Bellaire, TX 77402
Name
__________________________
Address
______________________________
City, State, Zip
_______________
Home phone:
_______________ Work phone: ________________
Fax:
_____________________ Email:
____________________
Amount of contribution:
_______
Check _____
Credit Card
VISA ____
MasterCard ____
Card Number
___________________________ Expiration _____
To support Lone Star
FIJA outreach, I would like contribute to your 12 X $12 program of monthly credit card
contributions:
Monthly amount:
$12.00 Other: ______
CONTRIBUTIONS ARE NOT
TAX DEDUCTIBLE
(we are a 501 c (4)
non-profit organization)
Check here if you wish to
become active with Lone Star FIJA _____
Check here to ensure that
your address is not provided to other groups _____
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Lone Star FIJA