MAIL-IN
DONATION FORM:(Please
print, complete and return with your check to the address below.)
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I
would like to make a contribution to help defend Dr. Ashqar. |
Enclosed
please find my donation of:
$20__$35 __$50 __$75 __$100 __$500 __$1000 _____Other $ ________
Name: ____________________________________________________
Street: ____________________________________________________
City: _____________________ State/Province:_____ Zip:____________
Email: _____________________________
Country: ________________
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| Please
make your check payable to: Free Dr. Ashqar Committee
and mail it with this form to:
FDAC
P.O. Box 151264
Alexandria, Virginia
22315-1264 |
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Privacy
Statement:We respect our supporters privacy. Information provided by
you will never be sold, rented, exchanged or otherwise disclosed to
any other organization. |
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