Name: ___________________________
Company:___________________________
Address:______________________________________
______________________________________
______________________________________
Daytime phone: (_____) ______________
Evening phone: (_____) ______________
Enclosed is my check to: Orange County Child Abuse Prevention Center
Or charge to my: ____Visa ____MasterCard
Credit Card#:________________________________
Expiration Date:____/____ Amount: _____________
Signature:__________________________
Your donation is tax deductible to the full extent of the law.
Print this form and mail or fax to:
Child Abuse Prevention Center
500 S. Main Street Suite 1100 Orange, Ca 92868
Phone: (714) 543-4333
FAX: (714) 543-4398