| Name: | ________________________________________________________ |
| Title: | ________________________________________________________ |
| Organization: | ________________________________________________________ |
| Address: | ________________________________________________________ |
| ________________________________________________________ | |
| Phone: | [ ] ___________________ | Fax: | [ ] ___________________ |
| Contribution Amount: | $ _______________________ |
Check one:
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My check payable to the National Consumers League is enclosed. | |
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Please send an invoice to the following address: | |
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___________________________________________________ | |
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___________________________________________________ | |
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Charge my contribution to my credit card account with (circle one): | |
| American Express | VISA | MasterCard |
| Card #: | _________________________________________________ |
| Expiration Date: | _________________________________________________ |
| Signature: | _________________________________________________ |
National Consumers League
1701 K Street NW, Suite 1200
Washington DC 20006
For credit card charges or invoice requests, form may be faxed to (202) 835-0747.