Anti-Prejudice Consortium Sponsorships
Response Form
(Please copy and return with your donation)

I am honored to become a SPONSOR of APC at the following level.

o Visionary:                  $25,000

o Legacy:                      $15,000

o Premiere:                  $10,000 

o Patron:                         $5,000

o Benefactor:                 $2,500

o Sustainer:                    $1,000 

o Supporter:                      $500

o Contributor:                    $250  

 Name_________________________________________________________________________

Company Name________________________________________________________________

Address________________________________________________________________________

City_______________________________State_________________________Zip____________

Phone__________________________ Email _________________________________________

Please make checks payable to The Anti-Prejudice Consortium.

____Please send an invoice.

____Please charge to my credit card.
(you may also donate by credit card at www.antiprejudice.org/support.html):

Card: o Visa                         o Mastercard                o American Express

Account #____________________________________ Exp. Date _______________________