Fill out your Personal or Business Information:
| ___New Doner ___Return Doner
Return Doner(Date of last donation): ____/____/____ |
| Name:_______________________________________________________________ |
| Address:____________________________________________________________ |
| City/Prov:______________________________ State: _____
ZIP: ________ Country _________ |
| Daytime phone: (____) _______________
Today's Date: ___/___/___ |
Donation & Free Ebook:
Donation (Check one): ___ w/free e-book ($35
$40 donation)
____$70 donation w/e-book ____$105 donation w/e-book ____$140 donation w/e-book |
|
Donation & No Ebook:
| Donation (Check one): ___$10 donation no e-book ___$15 donation no e-book ___$20 donation no e-book ___$30 donation no e-book |
| I want to donate ($30)per child for a Child Stranger Event(7 child min)______ Total children, Total cost $_______________________. |
| I want to donate ($10)per child for a Bullies Event(7 child min)______ Total children, Total cost $_______________________. |
| I want to donate ($10)per child for a Fitness & Nutrition Event (7 child min)(coming soon)______ Total children, Total cost $_______________________. |
Donation Amount:
| Total Donation Amount
$_______________________. |
Donations given to Child and Adult Safety Education Services, Inc (CAASES)
Could be tax deductible as charitable contribution for income tax purposes. Ask your tax accountant. |
Payment Information:
| ___Personal check ___Money Order ____E-check ___Cashiers check (payable to Child and Adult Safety Education Services, Inc ) |
| Charge to credit card ___Mastercard
___Visa ___Discover ___American Express |
| Account #: __
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. __ __/__ __ |
Signature:X (Sorry No Mail
in Credit card donations taken at this time) |
|
Mail application and payment
to: Child And Adult Safety Education Services, Inc (C.A.A.S.E.S.) Non-profit Organization
5029 E Cambridge Ave PHX,AZ 85008 |
| |