Senior and Student $25 • Active Member $35 • Family Member $50 • Sustainer $100 • Bronze Circle $500 • Silver Circle $1000 • Gold Circle $2500 • Platinum Circle $5000 • U.S. residents only Back to the Grand Vision Foundation website
First Name: Last Name:
Address:
Day Phone: ( ) Eve Phone: ( )
Or print this page, complete the additional information below and send it:
by fax with your credit card number to 310- 833-6362
or by mail with a check made payable to Grand Vision Foundation or credit card number: Grand Vision Foundation 434 W. 6th Street San Pedro, CA 90731 Indicate your method of payment: Enclosed is my check payable to Grand Vision Foundation Please charge my Visa Mastercard American Express
or by mail with a check made payable to Grand Vision Foundation or credit card number:
Grand Vision Foundation 434 W. 6th Street San Pedro, CA 90731
Indicate your method of payment: Enclosed is my check payable to Grand Vision Foundation Please charge my Visa Mastercard American Express
Signature: _____________________________________________ Exp.
Security Code (last three digits of the number shown above the signature strip on the reverse side of the credit card)
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