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Sustaining Supporters |
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Thank you to Our Current Sustaining Supporters:
Ken Perkins, Tri-State Financial Services |

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Your Information: Name of Group (as desired for display in the “Outspokin’”) |
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Name of Group_________________________________________________________ |
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Contact Person:__________________Contact Phone number __________________ |
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Mailing Address:_______________________________ |
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City, State, Zip:________________________________ |
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Number of people within the group: _____________ |
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Amount Enclosed: __________________ (check or credit) |
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Pay by credit card (check one) MC____ VISA___ |
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Name exactly as on card______________________________ |
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16-digit card#____________________________________Expiration date___________ |
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Signature_______________________ |
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Return Completed form with payment to: |
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ABATE of Ohio, Inc. |
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Attention: Sustaining Supporter |
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To Join our List of Sustaining Supporters, Print this page, complete the form below, and mail to ABATE of Ohio’s State office with your Check or Money Order for $100, or to use a credit card, fill out the credit card information on the form below. |