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Printable Donation Form

To make your gift, please print and fill out this form, then:

Fax it (with your credit card information) to 518-427-0381
   - or -
Mail it (with your check, money order, or credit card information) to:

Att: Web Donations
Environmental Advocates of New York
353 Hamilton Street
Albany, NY 12210

Make checks payable to:
Environmental Advocates of New York

I would like to contribute (check one):*

     __ $35      __ $50      __ $75      __ $100      __ $250      __ $500 

     __ Student/limited income ($15)      __ Advocate's Circle ($1000) 

     __ Other Amount: $___________

* Members receive our monthly publication Green Sheet New York, the NYS Voters' Guide (published by our sister organization EPL/Environmental Advocates), and discounts on our publications and conferences.

Name:
Address:
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ZIP Code:
E-mail Address:
___ Please do not share my information with other oganizations.

To donate by credit card, please provide this additional information:
Name (as it appears on card):
Credit Card Number:
Expiration Date (MM/YY):
Credit Card (circle one): AMEX | VISA | M/C | Discover
Signature:

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