WSA World Donation Form

If you wish to make a donation, please print the following form, fill it out, and mail it along with your donation to one of the addresses shown on the previous page.

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I am pleased to donate to the following:                  AMOUNT

1. World Government Treasury Account                     ________

2. World Service Authority®                              ________

     a. General Services                                 ________

     b. World Refugee Fund(sm)                           ________

     c. World Legal Fund(sm)                             ________

     d. World Law Internship Program(sm)                 ________

     e. World Citizen/Government News(sm)                ________

     f. World Syntegrity® Project                        ________

     g. World Citizen Web                                ________

     h. Electronic Communication                         ________

                                                 TOTAL   ________

Or:

I wish to donate $________(amount), ________(number) times per year.




Name_________________________________________________________________

Address______________________________________________________________

_____________________________________________________________________

Phone:___________________________Fax:________________________________

E-mail:______________________________________________________________


I am a registered World Citizen:  Yes___No___

Registration Number:_________________________

------------------------------- CREDIT CARD DONATION FORM --------------------------------

You may make donations to the World Service Authority by credit card.

Please complete the form below and return it to the WSA with the completed contribution form above. Please include a photocopy of the front and back of the credit card. Please note that there are NO REFUNDS or EXCHANGES. Please note that due to the effective legal and political advocacy of the WSA, in addition to its educational programs, donations are not tax-deductible despite its non-profit status.

Type of Credit Card (Check One):

___ Visa  ___ Mastercard  ___ Discover  ___ Diner's Club ___ American Express

Credit Card Number:_______________________________

Expiration Date (Month/Year): ____________________

Name as it appears on the card: ____________________________


Authorized Signature and Date: _____________________________

Telephone and email of Cardholder ___________________________

Billing Address
including Postal (Zip) Code: _______________________________

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Thank you for your very generous contribution.

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