Make
me a member at the:
•
Freedom Level $1000
•
James Madison Level $500
•
Thomas Jefferson Level $250
•
Thomas Paine Level $100
•
Samuel Adams Level $25
Total
Membership Dues Enclosed $__________
Underwriting
and sponsorships for individual projects are
also available. Please contact the FOIFT office
for further information.
My
check is enclosed in the amount of $ _________
Please
bill my American Express or Discover Card. #__________________________________
Expiration
date_____/_____/_____
Signature___________________________
Name
_______________________________________________
Affiliation/Company
____________________________________
Address
_____________________________________________
City
________________________ State _____ ZIP__________
Phone
____________________ Fax_______________________
E-Mail_______________________________________________