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Home > What You Can Do > Join Us > Donate By Mail
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Donation Information

All members receive Amnesty Magazine

Donate by Mail

To mail your check or money order, just print one of the forms below, fill out the information, and mail to: Amnesty International USA, 5 Penn Plaza, 16th Floor, New York, NY 10001. If you have questions, please call us at 1-800- AMNESTY.

If you cannot open PDF documents, please print and mail the form below.

* Indicates a required field.
 
Type Of Donation:
Join ____
Renewal ____
Student and Youth Membership ____
Gift Membership ____
  Notify recipient____Yes ____No
  Occasion____________________
Monthly Giving ____
Memorial Gift ____
Honorary Gift ____
Additional Gift ____
*Donation Amount:
$25 ____
$50 ____
$75 ____
$100 ____
$250 ____
$500 ____
 Other $____
 
Your Name & Email
*Email:  ____________________
*Prefix:  ____________________
*First Name:  ____________________
Middle Name/Initial:  ____________________
*Last Name:  ____________________
Suffix:  ____________________
 
Billing Address
*Address Line 1:  ____________________
Address Line 2:  ____________________
*City:  ____________________
* State/Province:   ____________________
*Zip/Postal Code:  ____________________
*Country:  ____________________
   
 
Phone Contact
Home Phone:  ____________________
 
____ Check box if your current address is the same as your permanent address.
Mailing List Subscriptions
Subscribe to: 
____ Online Action Center
Sign-Up to receive action alerts from Amnesty International USA's Online Action Center on urgent cases needing your immediate help.
____ Amnesty Online
Receive news, items of interest, and action alerts from Amnesty International USA. Amnesty Online is published every two weeks.
____ Please send me updates about upcoming Special Offers, Events and Membership Opportunities.
 
Payment Information
*Card Type: ____ Visa
____ MasterCard
____ American Express
____ Discover
*Card Number: ____________________
*Expiration Date:
____________________
 
Permanent Address
*Email:  ____________________
*Address Line 1:  ____________________
Address Line 2:  ____________________
*City:  ____________________
* State/Province:   ____________________
*Zip/Postal Code:  ____________________
*Country:  ____________________
Phone:  ____________________
School:  ____________________
Graduation Date
(mm/yyyy e.g. 05/2005): 
____________________
   
Please complete the sections below if you are making a Gift or Honorary/Memorial donation.
Recipient Name & Email
Email:  ____________________
*Prefix:  ____________________
*First Name:  ____________________
Middle Name/Initial:  ____________________
*Last Name:  ____________________
Suffix:  ____________________
 
Recipient Home Address
*Address Line 1:  ____________________
Address Line 2:  ____________________
*City:  ____________________
*State/Province:   ____________________
*Zip/Postal Code:  ____________________
*Country:  ____________________
   
 
Recipient Phone Contact
Home Phone:  ____________________
 
Print out this form and mail it to:

Amnesty International USA
5 Penn Plaza, 16th Floor
New York, NY 10001

or call 1-800-AMNESTY


   

Thank you!




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