Donation Form

Donations to the East Timor Action Network

Please print out form and mail to ETAN with your check.

____________ Donation $60__ $100__ $500__ (*tax-deductable) $35__ $15__ $__

____________ Send me the ETAN newsletter, Estafeta ($15 per year suggested, free if requested)

____________ Total

____________ Put me on the ETAN mailing list

____________ Put me in touch with others in my area

Name ______________________________________________________________

Address ____________________________________________________________

City _________________________________ State__________ Zip_____________

Phone ____________________________ Fax______________________________

E-mail ______________________________________________________________

Checks should be made out to: East Timor Action Network

*Tax-deductible contributions over $50 payable to: AJ Muste Memorial Institute

Mail to:
ETAN/US