Context Institute Mail Donation Form

Print out this form, fill it in, then mail it to us at the address below.

1. Donation Amount in U.S. Currency $______________ Thank You!

2. Method of Payment

a. Check or Money Order -- Please make payable to Context Institute, fill out section 3 below, and mail it to the address at the bottom of this form.

b. Credit Card -- Please specify one of:   ___Visa    ___MasterCard

Your credit card number ___________________________

Expiration date (mm/yy or mm/dd/yy): ___________________

Name as it appears on your credit card: _____________________

Signature: ___________________________________________

3. Information about you so we can send you a thank you and receipt

Name ______________________________________________________

Street Address ________________________________________________

City _______________________________________________________

State _______________________________________________________

Zip or Postal Code ___________________________________________

Country ___________________________________________________

Day phone:________________________________________________

Evening phone:_____________________________________________

email address_______________________________________________

Context Institute * PO Box 946 * Langley, WA 98260 * USA
Tel: 360/221-6044 * Fax: 360/221-6045