Please fill out the following form and send to:

 American Jewish Committee
6 Piedmont Center
Suite 510
Atlanta, GA 30305

Fax (404)261-2344

To support the American Jewish Committee’s effort to improve intergroup relations, defend democratic values, promote human rights and improve the quality of American Jewish life, I have enclosed a donation in the amount of $__________.

Please check one of the following:

____ Enclosed is my check                              ____ Please charge my credit card

Name:  _________________________________________________________________

Address: _______________________________________________________________

City: ________________________ State: ____________ Zip: ___________________

Phone: ____________________________ Cell: _______________________________

Email Address: __________________________________________________________

Type of card: ____ Visa ____ Mastercard ____ AMEX ____ Discover

Card Number: ___________________________________________________________

Expiration Date: _________________________________________________________

Signature: ______________________________________________________________