1.  I would like to help start LAAC programs in my community. My initial pledge amount is $60 for the first half year. I will receive a Children's Wellness Guide, a monthly e-zine, a quarterly newsletter, a calendar of events, and a Special Gift.

Please select your Special Gift (value $60):

A FREE 3 HOUR HOME HEALTHCARE WORKSHOP FOR MYSELF AND A GUEST

A FREE 2 HOUR HEALING MASSAGE WORKSHOP

A FREE HEALTH & BEAUTY TREATMENT AT “The Healing Rose Holistic Skin Care Center” in Woodland Hills

No, I don't need these gifts, instead I wish to make a Tax Deductible donation of $.

2.  The Payment Schedule I prefer is:          (Payments payable to SEE/LAAC)

Start up Payment of $60 or more $        Annual Payment of: $

Quarterly Payments of:
$30   $60    $75    $90    $105   $120    Other $

Monthly Payments of:
$10   $20    $25   $30    $35   $40   Other $

MY CONTACT INFORMATION

Name:
Address:
City:
State:
Zip:
E-Mail Address:
Phone #:

I AUTHORIZE SEE/LAAC TO RECEIVE THE FOLLOWING DONATION FROM MY ACCOUNT
My preferred method of payment is:      Note: Payment will be drawn on the 15th day of the month

CREDIT CARD ACCEPTANCE FORM Name on Card:  Billing Address:  City:   State:    Zip:  Please note: The name “Social and Environmental Entrepreneurs” (or some version thereof) will appear on your credit card statement, NOT the project's name.

TYPE OF CARD Visa MasterCard Discover/Novus Card Number #:  Exp. Date:  Amount $

I understand that:

l once my $60 pledge amount is fully paid, I will receive my special gift.
l upon sending my pledge form, I will receive my Pledge Partner card, a postcard to claim my selected workshop gift, a list with workshop dates, LAAC brochures, and my Children's Wellness Guide.
l updates and agenda's will be e-mailed or mailed to me regularly.
l as a Pledge Partner, I am eligible for special discounts toward certain services & products.
l I can contact the LAAC office to change or cancel my contribution.
l for every $10 I pledge, I receive a credit towards the fee for any workshop, and my credits accumulate every month.
l my pledge amount is not tax deductible if I choose to receive credits toward workshops.
l I can, at any time, make an additional tax deductible donation to further support LAAC.
l my payments will solely be used to benefit the outreach and advancement of LAAC parent
education programs.

For further questions please call (626) 798-1592 or write to the address above.
        

Please use this area for notes or comments you would like to make.