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Please print, fill out, and return to ALCTS with your donation.
Thank you for your support!
| Name | |
| Address | |
| City | State | Zip | |||
| Phone | () | ||||
| Donation: (please circle) | $50 | $100 | $150 | $250 | $500 |
| Payment (please specify) |
Check Enclosed |
Credit Card: |
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| AmEx | VISA | MasterCard | |
| Name (as it appears on card) |
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| Card number | |||
| Expiration Date | |||
| Detach and return with your donation to: | ALCTS $50 for 50 50 E. Huron St Chicago, IL 60611 |
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