DONOR/VOLUNTEER FORM

Print out this form and mail it to the address below.

Name:______________________________________

Address:____________________________________

City:_______________________________________

State:________________ Zip:__________________

Phone:_________________ Fax:________________

E-mail:_____________________________________

Endorsement Signature:__________________________________

I will help Save Our State by:

___Making a Donation; ___Gathering Signatures

Enclosed is a donation in the amount of:

___$10,000   ___$5,000   ___$2,500   ___$1000
___$750   ___$500   ___$250   ___$99   ______Other

Make all checks payable to:
Save Our State
P.O. Box 5250
Buena Park, CA 90622-5250

Contributions are not deductable for income tax purposes. California Law requires that a person contributing $100 or more provide occupation and name of employer.