Print and complete contribution form and return to:

Girls Learn International, Inc.
252 Seventh Avenue
Suite 3F
New York, NY  10001
telephone: 212-707-8577
fax: 212-707-8317

Back to Girls Learn International.

YES I would like to join Girls Learn International in the campaign

"Educate a Girl; Empower a Woman"

I would like to make a tax-deductible contribution of:

__ $25 __$50 __$100 ___ $250 ___ $500 ___ $1000 __ Other _______

First Name: ______________________________

Middle Initial:_______

Last Name:______________________________

Street Address: ______________________________

City: ______________________________

State:_____________

Zip/Postal Code: ______________________________

Country: ______________________________

Daytime Telephone: (_____)___________________________

Evening Telephone: (_____)___________________________

Fax: (_____)___________________________

Email:

I am enclosing a check _____

-or-

My credit card is: __ Visa ___ Mastercard

Credit Card Number ______________________________

Expiration Date (MM/YY): _______

Cardholder's Name: ______________________________

Billing Address, If Different From Above:

Street Address: ______________________________

City: ______________________________

State: ________

Zip/Postal Code: ______________________________

Country: ______________________________