I would like to help the Citizens for Peraica by making the following contribution:

__  Benefactor
__  Patron
__  Sponsor
__  Supporter
__  Friend
__  Other Amount

   Name:___________________________________

Address:___________________________________

        ___________________________________

  Phone:___________________________________

 

I can't contribute right now, but I would like to help by

__ Distributing literature
__ Working in the admin office
__ Other:__________________________________

         __________________________________