50/50 Donation Coupon

Please print, fill out, and return to ALCTS with your donation.

Thank you for your support!

Name
Address
City State Zip
Phone () Email
Donation: (please circle) $50 $100 $150 $250 $500
Payment (please specify)
Check Enclosed

Credit Card:
AmEx VISA MasterCard
Name
(as it appears on card)
Card number
Expiration Date
Detach and return with your donation to: ALCTS $50 for 50
50 E. Huron St
Chicago, IL 60611