UAI DONATION FORM

Please print and use this form for contributions to UAI. Once completed,
mail or fax (773-572-1181) this form and your donation to:
       Urantia Association International
       559 West Diversey Parkway #351
       Chicago, IL  60614  USA

Inquiries, phone: 773-572-1180 or e-mail: UAI Central Office

Personal Details

NAME:   ______________________________________________________________

ADDRESS 1:   _________________________________________________________

ADDRESS 2:   _________________________________________________________

CITY/TOWN: __________________________________   STATE or Province: _______________________

COUNTRY: _________________________________   ZIP or Postal Code: _________________________

PHONE:   (home) _____________________________    (work) __________________________________

EMAIL:  ______________________________________________________


Payment Details

Please make checks or money orders payable to "UAI" or "Urantia Association International"


Make sure checks and money orders from outside of the USA are in US dollars.
Please accept my tax deductible contribution of (please check one)

           $500       $100       $50      $____________

           I enclose a check or money order, OR

Charge my Visa     MasterCard    AmEx    BankCard

Card No:      _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _

Expiration Date:   _______ / _______

Name on Card:   _________________________________________________

Signature:   _____________________________________________________

Date:   ___________________________

 

 

 

If checked here I authorize regular monthly credit card charge until I issue written notice of cancellation.

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©2005 Urantia Association International. For more information contact UAI Central Office          Top of Page  UAI Home