Child And Adult Safety Education Services, Inc (CAASES) A 501 (C) 3 Non Profit Organization Seminar, Donation or Product Application Please fill out and mail this form to the address indicated at the bottom of the page.  

Mail in Donation, Seminar, Class, and DVD Order form Thank you

EIN:20-3748692

Fill out your Personal or Business Information:  ___New Doner   ___Return Donner   Return Donner(Date of last donation): ____/____/____ Name:_______________________________________________________________ Address:____________________________________________________________ City/Prov:______________________________ State: _____ ZIP: ________  Country _________ Daytime phone: (____) _______________   Today's Date: ___/___/___ Foreign Product orders will be subject to additional postage. charges. See 'Amount Due' section below "Not at this time".

Seminar/Class ____Yes, ___No (check one):  $_____ Refuse To Be A Victim 4 hour Seminar. Seminar Location _ ____$20ea. Rape/Date Rape class   ____$20ea. Home Invasion class   ____$20ea. Weapons class  ____$20ea. Self Defense class ____$150ea. 10 week 3 times a week Kick-N-Fitness Family class ____$500pk. for 4 people 10 weeks 3 times a week Kick-N-Fitness class ages 8 up ($100.00 savings) Donation ____Yes, ___No (check one): fill in Donation amount: I would like to Donate $__________.00 _____Refuse To Be A Victim 4 hour Seminar, _____Rape/Date Rape class, _____ID Theft class, _____Home Invasion class, _____Weapons class, _______ Self Defense class, _____Kick-N-Fitness class DVD/Kit ___Yes, ___No (check one): (Weapons Escape)DVD ages 14-adult. $15.00 x ____ = ______total DVDs ($15.00 ea. 1-5 DVDs) (Home Invasion)DVD Ages 14-adult. $15.00 x ____ = ______total DVDs (Rape/Date Rape)DVD ages 13-Adult. $15.00 x ____ = ______total DVDs (Self Defense)DVD ages 14-Adult. $15.00 x ____ = ______total DVD (Combo Fingerprint & DNA Kit) ages 5-Adult. $5.00 x ____ = ______total Kits Amounts: Donation subtotal                     $__________.00 Product subtotal                     $___________.00 Foreign Postage Canada $10, Other $20 $________.00 (Not at this time) Total Donation, Seminar, Class, or Product Amount      $_______________________.00 Donations given to Child and Adult Safety Education Services, Inc (CAASES)A 501 (c) 3 Non Profit Organization Could be tax deductible as charitable contribution for income tax purposes ask your tax accountant. Payment Information:  Payable to: (CAASES) ___Personal check  ___Money Order  ___Cashiers check  ___ Business Check Charge to credit card     ___Mastercard  ___Visa  ___Discover    ___American Express Account #:  __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __  Exp. __ __/__ __ __ __ Security Code#__________   Must give email with Credit Card_______________________________________________ Signature:X____________________________________________  Mail application and payment to: Child and Adult Safety Education Services, Inc 5029 E Cambridge AVE. PHX, AZ 85008