FOTWA DONATION & PRODUCT
FAX/MAIL ORDER FORM

Please print this form and fax or mail to FOTWA.
FOTWA is a 501(c)(3) tax-exempt organization. Tax ID# 77-0296291.

I'D LIKE TO SPONSOR A:

Tibetan Child:   $105 Quarterly   (SC)

Tibetan Elder:   $105 Quarterly   (SE)

Tibetan Family:   $105 Quarterly   (SF)

Tibetan Disabled Person:   $105 Quarterly   (SD)

Tibetan Tuberculosis Patient:   $105 Quarterly   (ST)

Tibetan College Student:   $210 Quarterly   (SU)

I'D LIKE TO MAKE A DONATION:

Make a General Donation:   $25   (GD01)

Make a General Donation:   $100   (GD02)

Make a Donation to Art Refuge:   $75   (AR01)

Become a Member:   $40 Annually   (MB01)

I'D LIKE TO PURCHASE THE BOOK:

AEP The Art of Exile: Paintings By Tibetan Children in India
($29.95 paperback + $6 UPS shipping & handling) = $35.95

AESC The Art of Exile: Paintings By Tibetan Children in India
($45.00 slipcased + $6 UPS shipping & handling) = $51.00

PERSONAL & SHIPPING INFORMATION

Date _________

Name ___________________________________________________

Address ________________________________________________

City, State, Zip ________________________________________

Country ________________________________________________

Telephone ______________________________________________

Fax ____________________________________________________

Email __________________________________________________

Ship to _______________________________________________

Credit Card: MasterCard ( ) VISA ( )

Card # _______________________________________________

Expiration Date: _____________

Credit Card Billing Address: ______________________________

Signature: ____________________________________________

Thank you for your contribution to FOTWA & Tibetan refugees.

Please send donation/order to:

Friends of Tibetan Women's Association
P. O. Box 31307 • Santa Fe, NM 87594
voice: 505-988-1938 • fax: 505-988-1938