Please print, complete and send by mail or fax.
|Pledge Type (check one):||Individual Group|
|Check/Money Order Enclosed (Payable to: A.A. Cleveland District Office)|
|Charge my (check one) Visa MasterCard ($20.00 minimum credit card donation)|
|3-Digit # (back of card):|
|Zip Code card issued in:|
|Total Donation Amount:|