Make me WYSER!

Please print, fill out, enclose donation & send to:
WYSE National Resource Office
634 S. Spring St., Suite 902
Los Angeles, CA 90014

Please accept my contribution of:

$1000_____   $500_____   $250_____   $100_____   $50______   Other_____
A check is enclosed. **Please make all checks payable to "Community Partners fbo WYSE"
Please Bill my credit card. **Please note the charge will show up as "Community Partners"
Please mark the appropriate circle:
Visa MasterCard
American Express Discover
Account Number: __________________________________ Exp. Date: ____________
Signature: ____________________________________________________________
Name: ________________________________________________________________
Organization Name: _____________________________________________________
Address:  _____________________________________________________________
City: ___________________ State: _______________________ Zip: ______________
Home Phone: ______________ Work Phone: ________________  Fax: _____________
Email: ________________________________________________________________
I would also like to:
Receive the Friends of WYSE newsletter
      _____via e-mail    _____via US Mail
Learn more about the Middle School and High School Program
Learn more about the WYSE Womyn Network
Host A WYSE Gathering

Thank you!

A confirmation letter will be sent to you upon receipt of this form.