Jonestown Memorial Wall Fund / Cherish the Children Donation Form

Name:

Company:

City: State: Zip:

Business Phone: Fax:

Home Phone: Email:

__Enclosed is my/our check or credit card authorization in the amount of

Please input card number here.

___Visa ___MC __AMEX

Name as it appears on the card:

Signature:

Please make Checks Payable to: Jonestown Memorial Wall Fund

c/o Dr. Jynona Norwood

645 W. Arbor Vitae

Inglewood, CA 90301

I/We would like to support the:

_____25^th Year Silver Anniversary Documentary

______The Cherish The Children and Stop The Violence Walk A Thon in

______Los Angeles ______Oakland

______The Jonestown Memorial Wall Cherishing the Children

______ 25^th Year Tribute Journal

TRIBUTE JOURNAL

____Back Cover Silver Sponsorship $1,000

____Inside Front Cover Children’s Sponsorship $500

_____Inside Back Cover Educational Sponsorship $250

_____Silver Full Page $125

_____Half Page $100

_____Quarter Page $50