Contribution Form

Date __________

Member ____ Non–member ____

Name _______________________________________________ Chapter # (if applicable) _______

Address _________________________________________________________________________

City/State/Zip _____________________________________________________________________

Phone (_____ )__________________________ E–mail address _____________________________

I heard about Mothers & More from ___________________________________________________

Contribution amount (in U.S. funds)

Yes, I want to invest in Mothers & More’s future and a brighter future in general for sequencing mothers! Here’s my tax–deductible donation of

_____ $25 Friend
_____ $30 Family
_____ $50 Advocate
_____ $100 Mentor
_____ $250 Visionary
_____ $500 Millennium Club

_____ Other amount (please specify) $________

Method of payment

____ MasterCard ____ Visa

Name on card ____________________________

Card number _____________________________

Exp. date (m/y) ___________________________

Signature ________________________________

____ Check, payable to Mothers & More

We appreciate your support!

Mail to: Mothers & More, P.O. Box 31, Elmhurst, IL 60126–0031. Credit card donations only may fax to: (630) 941–3551. Your donation to Mothers & More, a 501(c)(3) not–for–profit organization, is tax deductible. Questions? Contact the Mothers & More National Office at (630) 941–3553, or at nationaloffice@mothersandmore.org.

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Mothers & More
Headquarters • P.O. Box 31 • Elmhurst, Illinois 60126
(630) 941-3553 • [Fax (630) 941-3551] info@mothersandmore.org

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