| Name:____________________________________________________________ |
| Address:__________________________________________________________ |
| _________________________________________________________________ |
| _________________________________________________________________ |
| Phone #:__________________________________________________________ |
| E-Mail Address:____________________________________________________ |
Enclosed is my tax-deductible contribution of: |
___ US$500+ (Program Sustainer)
___ US$100+ (Program Supporter)
___ US$25+ (Associate)
cheap hotel in Jelenia Gora ___ I would like to receive Breakthrough News and GEA announcements.
___ Enclosed is an additional contribution of US$_____ for GEA's work. |
| Print out form and send request to:
Global Education Associates
475 Riverside Drive, Suite 1848
New York, NY 10115 |
