Printable Donation Form

Learning Leaders needs your support to help recruit, train, and support 
our volunteers.  Please send your tax-deductible gift today -- to give
ordinary New Yorkers the chance to do extraordinary things!

To make your gift, please print and fill out this form, then fax it
(with your credit card information) to: 212-213-0787 or mail it (with
your check, money order, or credit card information) to:

Learning Leaders
80 Maiden Lane, 11th Floor
New York, NY 10038-4811

Make checks payable in US dollars to: Learning Leaders.


Donation ___ $25  ___ $50  ___ $100  ___ $250  ___ $500  _________ Other.

  
    Name _______________________________________________________________

    Address ____________________________________________________________

    City ___________________   State/Province ________    Zip __________

    Country ________________   Email ___________________________________



For credit card donation, please provide this additional information: 

    Name (as it appears on card) _______________________________________

    Credit Card Number _________________________________________________

    Expiration Date __________ (MM/YY)

    Credit Card (circle one) American Express | MasterCard | VISA

    Signature ________________________________



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