Second Annual Citizens Awards - October 30, 2008

Sponsor's Form

Yes, I would like to be listed as a sponsor of the Second Annual Citizens Awards.

Please find enclosed a donation of:

*$250.00                 * $500.00                    *$1,000.00              *Other $_____________

*Please send me a receipt from Citizens Against Recidivism, Inc.

Contact Details:

Name:  ____________________________________________________________________

Name of organization: ________________________________________________________

Address: ___________________________________________________________________

Telephone: _________________________________________________________________

Email: _____________________________________________________________________

Payment Details:

*I have enclosed a check/money order (payable to Citizens Against Recidivism, Inc.)

Please charge to: * Visa       * Master Card       * American Express

Credit card# _______________________________expiration date: ______________

Security code ____________________[1]

Name on card: _________________________________________________________

Billing address: ________________________________________________________

  ________________________________________________________

Signature:         _________________________________________________________

Thank you for your support

Please print and return this donation form to:

Citizens Against Recidivism, Inc.

Box 9 – Lincolnton Station

New York, New York 10037