Contributor Form

I am pleased to support FOHS. Enclosed is my contribution of:

$1,000
$500
$100
$50
$25
Other: $

Allocate my contribution to:

All Funds split equally    
Jeff Lee Lecture Fund    
General Fund    
Sustainable TLV®/BEI® Fund    
Worldwide Outreach Program (WOP)    

I would like to be considered as a future presenter of the Jeff Lee Lecture.

I would like to serve on The Board of Trustees.

 Mr.     Mrs.     Ms.     Dr.   
First Name:
Last Name:
Organization:
Street:
City/State/Zip:
Country:
Phone:
Fax:
E-Mail:

How would you like your name listed as a contributor?

Anonymous, or Other :

Method of payment:

Check*. Print this form and mail with check payable to:
FOHS
1330 Kemper Meadow Drive
Cincinnati, Ohio 45240, USA
Charge my:
VISA® MasterCard® American Express®  

Card #: Expiration Date:

Cardholder's Name:

Contributions are tax-deductible, as provided by law.

 

*DO NOT CLICK THIS SUBMIT BUTTON IF PAYING BY CHECK. Print this form and mail with check.

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