Page 217 - Systemic Reform Solutions
P. 217
DONATION FORM
Your donation helps spread awareness and helps with the planning development and
implementation of Systemic Reform Solutions.
Donate online at http://donate.Advancian.org or mail your donation to Advancian
Make Checks Payable to:
Advancian - or - NFP Initiatives (501c.3.)
332 South Michigan Ave., Lower Level - A67
Chicago, IL 60604
Phone Number: (312) 274-5055
DONATION DESIGNATION
Systemic Reform Solutions—the System Core
Donation Amount ($ USD): ____________________________
Donor Name: ______________________________________________________________
Address: __________________________________________________________________
City: ____________________________ State: ___________ Zip: __________
Phone: (______) _______ - ________________
Email: _________________________________________________________________
Systemic Reform Movement Membership
Foundation Member $60 Monthly $720 Annual
Foundation Hero $200 Monthly $2,600 Annual
Foundation Angel $435 Monthly $5,200 Annual
Major Foundation Donor $ ___________________________________
Advancian T-shirt - $40.00 Small Large XX Large
DONATE ONLINE AT DONATE.ADVANCN.ORG
206 | P a ge
