(Please print this form and return by mail to MWC)
Name:____________________________________________________________________________
Address: _________________________________________________________________________
City: ________________________________________________State:_____
Zip:______________
Email: _________________________________________
Phone: __________________ Fax: _________________
I would like to donate: ( )$25 ( )$50 ( )$100 ( )$500 Other:
_______
Please make checks payable to: Muslim Women’s
Coalition
Send this form to 1283 Rte 27, Somerset, NJ 08873
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