Serving the Polyamorous Community

Contribution Form

The Polyamory Society understands that privacy is a concern for many members and contributors. We fully respect this interest and honor it with our assurance that no names, addresses, phone numbers or other personal information will be sold, leased, or otherwise distributed. You can contribute secure in the knowledge that your contact information will be kept confidential.
Name:

Address:

City:

State:

Zip:

Telephone: (Optional)

Fax: (Optional)

E-Mail Address:

Donation Amount:

 

RESEARCH GRANT CONTRIBUTIONS

Academic       Cultural       Technological       Scientific

EDUCATION BRANCH CONTRIBUTIONS

PolyFamily       PolyParents       Children       Adult

OTHER CONTRIBUTIONS

PolyFamily Division       Scholarship Fund       Legal Affairs Division

Family/Friend Alliance       Self Improvement       PolyActivist Network

 

ADDITIONAL INSTRUCTIONS

Payment Type: VISA MasterCard AmEx
Please make checks payable to Polyamory Society *
Credit card processing is handled free of charge through HMJ Enterprises.
Card Number: Expiration Date:
Name on Card:
* If contributing by check, simply print and complete this form and mail it with your check to:
Polyamory Society, Inc., P.O. Box 8162, Silver Spring, MD 20910

Please take a moment to review your form to be sure everything is correct!

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