JOIN
THE FOUNDATION
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Your donation is tax-deductible.
The Foundation is a 501C3 tax-exempt, non-profit group.
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do not accept credit cards at this time. Please print this page out, and mail
it with your check to:
PO Box 492028 ·
Los Angeles · California 90049-8028
(310)471-0303 · www.Anti-smoking.org
I
want to join or make a gift to the Foundation
for a Smokefree America. I wish to support your work preventing teens
from starting to smoke, and empowering smokers to quit successfully.
First
Name __________________________ Initial_____
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(optional) _____________________________
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Address _________________________________
______________________________________________
City
_________________ State _____ Zip
__________
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1 (optional) ______________________________
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2 (optional) ______________________________
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e.m.a.i.l.
(required if newsletter desired)
______________________________________________
I
____would ____would not like to recieve your newsletter with news of the Foundation
and tobacco news updates, when it starts publication. (e.m.a.i.l. address required.)
I
understand I may unsubscribe at any time, and that my e.m.a.i.l., address and phone
will never be shared.
Enclosed
are my dues for a one-year membership as a —
____
$15 Student
____
$ 25 - $35 Supporting member
____
$50 Sustaining member
____
$100 Silver member
____
$250 Gold member
____
$500 Platinum member
____
$1,000 Friend
____
$5,000 Patron
____
$10,000 Angel Club
____
$ 25,000 Benefactor
____
$ 50,000 Premiere Benefactor
____ I pledge a major gift of $ __________________.
_____I
will consider a major gift in the range of __________________.
Patron or higher: Please have ___ Mr. Reynolds ___ your Director
of Development call me, to discuss my gift and a telephone or in-person
meeting.
Detailed
information about the Foundation's programs, goals and mission is posted
on the web at: www.anti-smoking.org/info.