* = required fields

*Name:

*Address:

*City:

*State:    *Zip:

*Phone:      Fax:

*Email Address:

*Repeat Email Address:

*Contributions:
$40 Basic Membership
$50 Friend
$100 Sponsor
Other Amount $
or

Green Certificates $
If you wish to purchase gift Green Certificates (see box at right), fill in your total amount above, then fill out the recipient information at the bottom of this page.

*Please bill my credit card: Master Card Visa

*Credit Card Number:

*Cardholder Name:

*Expiration date: /

Employee contribution match applied for
Please check with your employer to find out if they participate in an Employer Contribution Match program. All contributions are deductible to the full extent of the law.

I would like to become more involved with ANJEC. Please contact me.

Green Certificate Recipients

Recipient Name(1):
Gift amount: $
Recipient Address (1):
**
Recipient Name(2):
Gift amount: $
Recipient Address (2):
**
Recipient Name(3):
Gift amount: $
Recipient Address (3):
**
Recipient Name(4):
Gift amount: $
Recipient Address (4):
**

** Address optional; recipient of gifts of $40 or more are entitled to a free subscription to the quarterly ANJEC Report

All contributions are deductible to the full extent of the law.

Print this form using the print button in your browser window, then mail it to ANJEC, PO Box 157, Mendham, NJ 07945; submit it online using the Submit button below; or call ANJEC at 973-539-7547.

      

New! Green Certificates

A great gift idea and a great way to reduce your carbon footprint. Make a donation to ANJEC for those hard-to-gift friends and family. Then send them an ANJEC Green Certificate to let them know you care enough to protect the planet they live on.

Just check off Green Certificate under Contributions, and fill in the total gift amount for all recipients.

Then enter the name and individual gift amount for each recipient in the fields supplied.

Within one week, ANJEC will send you an acknowledgement and the ANJEC Green Certificates you request.

ANJEC Privacy Policy
ANJEC will not share, rent or sell your email address to any other organizations or corporations. If you decide you want no further contact with ANJEC, let us know at info@anjec.org.

11/07

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