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U2K Individual Participation

Please use this form to submit your individual contribution to the U2K campaign. If you would prefer to not send this information over the Internet, please print this page and mail it to us.

I/we will invest in changing the way our health care dollars are spent by supporting the U2K Campaign with a personal donation of:

$25
$50
$100
$250
Other  (please fill in amount here)


This is a monthly pledge

Please send me information on how to link up with U2K activists in my area.

Name
Address
State
Zip Code
Home Phone
FAX
E-mail

Check Sent (payable to "U2K Campaign")

OR

  Pledge $ to my Credit Card (NOTE: for Credit Card donations, please print this form out, and then fill in the credit card account information and mail it in*.)

Charge to MasterCard   Charge to Visa   Charge to AMEX

Account #      Exp. Date: 


Make checks payable to the "U2K Campaign." Contributions are tax deductible.

Mail to: U2K Campaign, 2800 Euclid Ave, #520 Cleveland OH  44115-2418

 

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U2K Campaign
2800 Euclid Ave., Suite 520 Cleveland OH 44115-2418         
Tel: 216/902-5577  Fax: 216/241-8423

U2K questions: uhcan@uhcan.org                Website questions u2kwebmaster@loebigink.com