Support PCI-Media Impact

Make a donation by mail
Download PCI-Media Impact donation form by clicking here (Adobe Acrobat Reader) and follow the instructions detailed in it.

OR

Print out this page, fill out the form below and mail it with your check or credit card information to:

PCI-Media Impact, Inc.
777 United Nations Plaza
New York, NY 10017-3521 USA

YES, I want to support PCI-Media Impact's efforts to motivate people to adopt new attitudes and behaviors that promote the status of women and girls, improve sexual and reproductive health, and foster individual, community, and national development.

Enclosed is my gift of $__________________

Name: ________________________________________

Address: ______________________________________

City:________________________ State: ____________

Zip:______________ Country: ____________________

Tel: __________________ e-mail: ________________________

____ I'm enclosing a check, payable to PCI.

____ Please charge the amount indicated above to my credit card.

Type of Credit Card (check one): ____ VISA ____ MASTERCARD

Credit Card Number: _________________________________

Expiration Date: _____________________________________

Name on Credit Card: ________________________________

Signature: ___________________________________________

____ I would like my gift to remain anonymous.

____ PCI-Media Impact needs the committed help of our members to achieve our goals of sustainable development. May we contact you in the future via e-mail to ask for additional support?

All contributions to PCI-Media Impact are tax-deductible to the fullest extent allowed by law.

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